Transabdominal laparoscopic inguinal hernia repair: is there a place for biological mesh?

Aim An ideal mesh should produce minimal foreign-body reaction and be compatible with human tissue. Studies focusing on these aspects indicate that a biological mesh acts as a scaffold for hernia repair. In this paper, we retrospectively evaluate a consecutive series of patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) hernioplasty using a biological mesh-Surgisis-fixed with fibrin glue, focusing on the feasibility of the technique and the incidence of complications, especially those related to the type of mesh implanted. Methods Between July and September 2006, 11 patients were operated on using TAPP hernioplasty (bilateral or unilateral) and applying a Surgisis mesh affixed by a fibrin sealant. Results The mean overall operative time was 75 (+/- 15) min. All of the surgeries were performed as a day surgery procedure. Any major or minor complications (early or late), such as prosthesis rejection and/or infection, were recorded. There was only one case of recurrence, likely due to technical error. The mean follow-up was 14.5 (+/- 1) months. Conclusion On the basis of this initial experience, TAPP hernioplasty with a Surgisis mesh affixed with fibrin glue is feasible, easy to perform, and effective in experienced hands, with good results. The well known characteristics of a minimally invasive and gentle approach, together with the type of mesh implanted and fixation using glue, might explain the encouraging results of this experience. Therefore, this type of mesh might be tailored to not only the sportsman or the patient with a contaminated surgical field, but may also be used in young patients, where there is a fear of leaving behind a long-term foreign body.