Abstract

The role of surgical adhesives in hernia repair has continued to evolve. The purpose of this chapter is to review the role of fibrin sealant and its application in general surgery for mesh fixation, specifically the history, biomechanics, and clinical utilization. The utilization of fibrin sealant for repair of groin hernias, both open and laparoscopic, ventral hernias, and hiatal hernias will be discussed.

Abstract

Mesh bacterial colonization/infection remains a critical issue in complex ventral hernia repair. Despite the recent emergence of biologic meshes, current strategies to prevent and treat mesh infection are largely ineffective, often leading to device failure and subsequent explantation along with the associated costs and effect on patient welfare. Unacceptably high rates of morbidity and hernia recurrence following mesh infection highlight the need for innovation in the area of hernia repair for the complex patient. One recent strategy to address such shortcomings is local antibiosis in the form of polymer coatings applied to the mesh itself. Current literature regarding the use of antibiotic-coated hernia mesh is limited but does illustrate the ability of these devices to inhibit bacterial growth and prevent mesh infection in both in vitro and in vivo studies. Although there is a paucity of literature regarding long-term clinical efficacy, this provides opportunity for further inquiry into a promising new development to combat mesh infective complications.