A Meta-Analysis Examining the Use of Fibrin Glue Mesh Fixation versus Suture Mesh Fixation in Open Inguinal Hernia Repair

Abstract

Background: The aim of this study was to systematically analyze the randomized trials comparing fibrin glue mesh fixation with suture mesh fixation in open inguinal hernia repair. Methods: Information was collected from a literature search using PubMed, Springer, Cochrane Library database and reference lists. The methodological quality of included publications was evaluated. Statistical analysis was performed using Review Manager Version 5.2.5 software. Results: Nine articles were identified for inclusion: four randomized controlled trials (RCTs) and five prospective observational clinical studies. All the trials were considered to be of fair quality. The results showed that there was a lower incidence of chronic pain (RR 0.42, 95% CI 0.22-0.79, I² 11%; p < 0.01), and hematoma/seroma (RR 0.43, 95% CI 0.21-0.87, I² 0%; p < 0.05) in the fibrin glue mesh fixation group. However, the results of meta-analysis revealed that the incidence of recurrence or urinary problems between the two procedures were similar. Conclusions: During the 6-15 months follow-up, fibrin glue mesh fixation is a feasible alternative for mesh fixation with sutures in open inguinal hernia repair. However, the poor quality of the included trials limits the evidence; rigorously designed trials are warranted to confirm this conclusion.

Factors predicting chronic pain after open mesh based inguinal hernia repair: ​A prospective cohort study

“…Role of mesh attachment with respect to pain has also been a center of interest. Disturbance of sensory nerves by penetrative fixation methods is suspected [32]. Here, mesh weight and attachment method categories showed covariance.…”

Randomized Multicenter Trial Comparing Glue Fixation, Self-gripping Mesh, and Suture Fixation of Mesh in Lichtenstein Hernia Repair (FinnMesh Study)

“…[5][6][7][8] Until now, there has been insufficient evidence to promote fibrin sealant, self-fixing meshes, or cyanoacrylate glues over a suture fixation of mesh. [9][10][11][12][13] Recent moderate-quality RCTs have suggested that both fibrin sealant and cyanoacrylate glue may have a beneficial effect on reducing immediate postoperative pain in risk populations, such as younger active patients. 7,10,12 Original fixation of mesh in Lichtenstein hernioplasty was performed by using nonabsorbable sutures medially at the pubic periost when fixing the upper corner of the mesh and continuous sutures at the inguinal ligament.…”

“…[9][10][11][12][13] Recent moderate-quality RCTs have suggested that both fibrin sealant and cyanoacrylate glue may have a beneficial effect on reducing immediate postoperative pain in risk populations, such as younger active patients. 7,10,12 Original fixation of mesh in Lichtenstein hernioplasty was performed by using nonabsorbable sutures medially at the pubic periost when fixing the upper corner of the mesh and continuous sutures at the inguinal ligament. 1,14 Since then, mesh fixation methods have been complemented by absorbable sutures, 15 various tissue glues, 6,7 and novel self-fixating meshes.…”

A Prospective Randomized Study Comparing Fibrin Glue Versus Prolene Suture for Mesh Fixation in Lichtenstein Inguinal Hernia Repair

“…The study by Liu et al [17] also showed that there was a lower incidence of chronic pain (RR 0.42, 95 % CI 0.22-0.79, I (2) 11 %; p<0.01) in the fibrin glue group.…”