Post-operative benefits of Tisseel(A (R))/Tissucol(A (R)) for mesh fixation in patients undergoing Lichtenstein inguinal hernia repair: secondary results from the TIMELI trial

作者：Campanelli G^*; Pascual M H; Hoeferlin A; Rosenberg J; Champault G; Kingsnorth A; d' Arc M Bagot; Miserez M

来源：Hernia, 2014, 18(5): 751-760.

DOI：10.1007/s10029-014-1263-3

• Inguinal hernia repair
• Mesh fixation
• Lichtenstein technique
• Chronic pain
• Chronic numbness
• Chronic groin discomfort

The Tisseel/Tissucol for mesh fixation in Lichtenstein hernia repair (TIMELI) study showed that mesh fixation with human fibrin sealant during inguinal hernia repair significantly reduced moderate-severe complications of pain 12 months post-operatively compared with sutures. Further analyses may assist surgeons by investigating predictors of post-surgical complications and identifying patients that may benefit from Tisseel/Tissucol intervention. %26lt;br%26gt;Univariate and multivariate analyses identified risk factors for combined pain, numbness and groin discomfort (PND) visual analogue scale (VAS) score 12 months post-operatively. Variables tested were: fixation method, age, employment status, physical activity, nerve handling, PND VAS score at pre-operative visit and 1 week post-operatively. The effect of fixation technique on separate PND outcomes 12 months post-surgery was also assessed. Analyses included the intention-to-treat (ITT) population and a subpopulation with pre-operative PND VAS %26gt; 30 mm. %26lt;br%26gt;316 patients were included in the ITT, with 130 patients in the subpopulation with pre-operative PND VAS %26gt; 30. Multivariate analysis identified mesh fixation with sutures, worsening pre-operative PND and worsening PND 1 week post-surgery as significant predictors of 12-month PND in the ITT population; mesh fixation with sutures was a significant predictor of 12-month PND in the pre-operative PND VAS %26gt; 30 subpopulation (p %26lt; 0.05). Mesh fixation with Tisseel/Tissucol resulted in significantly less numbness and a lower intensity of groin discomfort compared with sutures at 12 months; there was no difference in pain between the treatment groups. %26lt;br%26gt;Pre-operative discomfort may be an important predictor of post-operative pain, numbness and discomfort. Tisseel/Tissucol may improve long-term morbidity over conventional sutures in these patients.

• 出版日期2014-10