Use of fibrin glue for fixation of mesh and approximation of Peritoneum in Transabdominal Preperitoneal (TAPP) inguinal hernia repair: technical feasibility and early surgical outcomes.

BACKGROUND: It is a common practice to secure both mesh and peritoneum using tacks when performing a transabdominal preperitoneal (TAPP) inguinal hernia repair. The use of tacks to secure the mesh is well documented and has been associated with postoperative chronic pain. Recently, fibrin glue has been used to secure the mesh in these repairs but not used to reapproximate the incised peritoneum. This study assessed the technical feasibility of using fibrin glue for fixation of both mesh and peritoneum. PATIENTS AND METHODS: A total of 33 TAPP hernia repairs were carried out in 27 consecutive patients. In all the patients, both mesh and peritoneum were secured with fibrin glue (20 primary inguinal hernia repairs, 5 bilateral hernia repairs, 1 recurrent inguinal hernia, and 1 recurrent bilateral hernia repair). RESULTS: Patients were followed up at an outpatient clinic between the second and third week after surgery. Six patients were followed up through telephone. Patients were questioned on the following factors: residual postoperative pain (groin and port sites), unplanned GP or hospital visits, employment status and number of days between their surgery and return to both work and normal activities, and recurrence. No patients had residual groin or port site pain at a median of 21 days after surgery. No patient required an unplanned follow-up appointment with their GP. One patient (recurrent repair) developed a seroma postoperatively. Median time to normal activities was 10 days (range, 3 to 21 d). CONCLUSIONS: Total glue fixation of mesh and peritoneum is technically feasible and early results show low rates of postoperative complications and pain. Randomized studies are needed to confirm this.

Head roll influences perceived hand position.

Visual and proprioceptive sensory inputs are naturally coded in different reference frames, i.e., eye-centered and body-centered, respectively. To use these signals in conjunction for motor planning or perception ultimately requires converting them into a common frame of reference using estimates of the relative orientation of the eyes, head, and body. Here, we examine whether extraretinal signals-specifically head roll-alter multisensory perception through noisy reference frame transformations. To do so, we examine the accuracy of visual localization relative to proprioceptive hand position for different head roll orientations. Subjects were required to judge whether a visual target was located closer or further and left or right (4-alternative forced-choice task) from their unseen hand. This was done for three different head roll rotations (-30, 0, and 30 deg). We show that eccentric head roll increased the variability in the subjects' ability to discriminate target location relative to the fingertip. We conclude that sensory perception is sensitive to body-geometry-dependent noise affecting the coordinate matching transformations of sensory data.