Fibrin Sealant Effects on the Ilioinguinal Nerve

ABSTRACT

Background: Chronic pain after mesh repair for inguinal hernia may be related to the trauma to the regional nerves by direct compression with sutures, staples, or tacks during mesh fixation. Fibrin sealant (FS) has been recommended to eliminate this risk. In this experimental study, the effects of FS on the ilioinguinal nerve when a mesh was applied was searched. Materials and Methods: Fifteen New Zealand rabbits were used in three groups. In Group 1, a 2×1 cm, standard monofilament, pure polypropylene mesh was laid over ilioinguinal nerve. In Group 2, 0.5 ml FS was applied on the nerve without using an onlay mesh. In Group 3, a 2×1 cm mesh was laid onlay and secured with 0.5 ml FS with no fixating suture. Three months after surgery bilateral nerve samples were taken from the contiguous nerve segment for microscopic study. Results: Group 1 showed prominent findings with regard to all parameters. There were significant differences between Group 1 and Group 2 in respect of fibrosis, lymphocyte, and edema scores, and foreignbody reaction. The values of Group 3, where the mesh was secured by the application of FS with no suture, were roughly placed in between Group 1 and Group 2. Prominent fibrosis and increased collagen proliferation in peripheral area of mesh was seen in Group 1 subjects, whereas a mild fibroblastic activity among mesh fibers in Group 3 subjects. Conclusions: FS has no negative effect on ilioinguinal nerve. FS application may protect the nerve from the harmful effects of polypropylene mesh in inguinal hernia repair.

Keywords: :

• inguinal hernia
• ilioinguinal nerve
• postoperative pain
• fibrin sealant
• mesh
• experimental

ACKNOWLEDGMENT

We would hereby like to remember our colleague Murat Anlar, MD, Pathologist (1974–2009).

Declaration of Interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.