Preliminary experience using fibrin glue for mesh fixation in 250 patients undergoing minilaparoscopic transabdominal preperitoneal hernia repair.

PURPOSE: Fibrin glue for mesh fixation has been proposed to prevent the risk of nerve injury in inguinal hernia repair. We retrospectively evaluated a series of 250 patients who underwent minilaparoscopic transabdominal preperitorneal (miniTAPP) hernioplasty (using trocars, optics, and instruments <10 mm in diameter) in whom mesh fixation was achieved using 2 mL of fibrin glue. We considered the feasibility of the technique and the incidence of complications, especially those possibly related to mesh fixation. We also compared the results with an earlier series of 245 patients in whom tacks were used to fix the mesh. MATERIALS AND METHODS: Between April 2004 and November 2005, 250 patients underwent bilateral or unilateral miniTAPP hernioplasty with instruments, optics, and trocars smaller than 10 mm and meshes fixed by fibrin glue. RESULTS: The mean overall operative time was 52.25 +/- 15.2 min. All the procedures were done as day surgeries. We registered one intraoperative bladder lesion and 15 cases of seroma. There were no relapses, prosthesis rejection, or infection. The mean follow-up was 13.2 +/- 6.1 months (range, 5-24 months). CONCLUSION: On the basis of our initial experience, miniTAPP hernioplasty with a fibrin glue is feasible, effective, and easy to perform in experienced hands, with good results without higher risk of recurrence. In addition, the fibrin fixation method seems to decrease postoperative neuralgia and reduced the incidence of postoperative seromas and hematomas.

Malignant haemangiopericytoma of the mesorectum.

The authors report the case of a malignant haemangiopericytoma found in an uncommon location, namely the mesorectum. Haemangiopericytomas of the mesorectum are rare mesenchymal tumours of vascular origin that usually occur in the musculature of the extremities, retroperitoneum, pelvis (uterus, ovary and urinary bladder), head, neck and lungs. Rare sites include the liver, pancreas, stomach and greater omentum. Because of their rarity the overall experience has not been significant and little has been published concerning such tumours. In addition, the difficult interpretation of the histological evidence and the poor prognosis of the disease may still give rise to problems in terms of clinical management. Haemangiopericytomas of the retrorectal space, however, seem to behave like malignant tumours: the clinical course is poor and survival short, despite radical surgery, due to early distant metastases and local recurrence. Surgery still remains the mainstay of treatment. Adjuvant therapies should be considered.