Less Pain and Shorter Convalescence with Fibrin Sealant vs. Tacks in Mesh Fixation After Laparoscopic Hernia Repair

Noting that the use of tacks for mesh fixation may induce pain after laparoscopic ventral hernia repair (LVHR), Danish surgeons designed and conducted a randomized clinical trial to compare conventional mesh fixation using titanium tacks against fibrin sealant. Of 40 patients enrolled, 38 were available for intention-to-treat analysis after one month. Acute pain was the primary outcome, and was measured on a 0 to 100 mm visual analogue scale (VAS).

Patients in the fibrin sealant group reported less pain than those in the tack group on days zero to two after surgery, both at rest (median 19 versus 47 mm; p = 0.025) and during activity (38 versus 60; p = 0.014). The absolute difference in pain score between groups was 19 mm (95% confidence interval, 3 to 34) and 20 mm (95% CI, 4 to 35) at rest and during activity, respectively. Patients in the fibrin sealant group also resumed normal daily activity earlier (after a median of seven versus 18 days; p = 0.027), and reported significantly less discomfort. No hernia recurrences were observed.

The investigators concluded that mesh fixation in LVHR was associated with less acute postoperative pain, discomfort and a shorter convalescence than tack fixation. They suggested longterm follow-up to determine whether the benefits of fibrin sealant use persist in terms of chronic pain and non-recurrence.