The effect of TISSEEL fibrin sealant on seroma formation following complex abdominal wall hernia repair: a single institutional review and derived cost analysis

Purpose: The authors evaluated the ability of a fibrin sealant (TISSEEL™: Baxter Healthcare Corp, Deerfield, IL, USA) to reduce the incidence of post-operative seroma following abdominal wall hernia repair. Methods: We performed a 4-year retrospective review of patients undergoing abdominal wall hernia repair, with and without TISSEEL, by a single surgeon (FEE) at The Johns Hopkins Hospital. Demographics, surgical risk factors, operative data and 30-day outcomes, including wound complications and related interventions, were compared. The quantity and cost of Tisseel per case was reviewed. Results: A total of 250 patients were evaluated: 127 in the TISSEEL group and 123 in the non-TISSEEL control group. The average age for both groups was 56.6 years (P = 0.97). The majority of patients were female (TISSEEL 52.8 %, non-TISSEEL 56.1 %, P = 0.59) and ASA Class III (TISSEEL 56.7 %, non-TISSEEL 58.5 %, P = 0.40). There was no difference in the average defect size for both groups (TISSEEL 217 ± 187.6 cm², non-TISSEEL 161.3 ± 141.5 cm², P = 0.36). Surgical site occurrences occurred in 18.1 % of the TISSEEL and 13 % of the non-TISSEEL group (P = 0.27). There was a trend towards an increased incidence of seroma in the TISSEEL group (TISSEEL 11 %, non-TISSEEL 4.9 %, P = 0.07). A total of $124,472.50 was spent on TISSEEL, at an average cost of $995.78 per case. Conclusions: In the largest study to date, TISSEEL™ application offered no advantage for the reduction of post-operative seroma formation following complex abdominal hernia repair. Moreover, the use of this sealant was associated with significant costs.