Fibrinogen patch -- A cost effective way to prevent hernia recurrence

China: The recurrence of groin hernia after the repair can be lowered with the use of nanoscale fibrinogen, according to a recent study published in the Journal of the American College of Surgeons.

Inguinal hernia or groin hernia is one of the most common disorders that affect elderly men which often require corrective surgery. It occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. It can appear as a swelling or lump in the groin, or as an enlarged scrotum and may be painful.

Currently used synthetic permanent meshes for the prevention of groin hernia recurrence are associated with high rates of chronic pain in patients. Biological patches appear to limit pain but their higher cost limits restrict its use.

Jiangxiong Tang, Department of Surgery, Huadong Hospital, affiliated to Fudan University, Shanghai, China, and colleagues developed a low-cost fibrinogen patch consisting of a copolymer formed from porcine fibrinogen. They then compared this formulation with porcine small intestinal submucosa (SIS) biological patch.

The study had a noninferiority design and included 172 patients (median age, 61 years) with unilateral reducible groin hernia. The patients were assigned to experimental (n=86) and control (n=86) groups.

Key findings include:

• At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5·95%) and 2 (2/86, 2·35%) patients in the control and experimental groups, respectively.


• At 33 months follow-up, recurrence was observed in 2 patients (2/79, 2·53%) in the control group vs none in the experimental group (0/78).


• No significant differences were found in the degree of chronic pain and complications 33 months after surgery between the two groups.

The fibrinogen "patch is a safe and effective treatment for open tension-free inguinal hernia repair and combines the advantages of biological biodegradable grafts with reduced production costs," the authors conclude.

"Since the recurrence rates and postoperative complications after 33 months were not inferior in the experimental group, we believe that the P(LLA-CL)/fibrinogen patch as a low-cost alternative has prospects for widespread clinical use," they wrote.

To read the study in detail follow the link: https://doi.org/10.1016/j.jamcollsurg.2019.08.1446