Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials

Abstract

Background The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. Methods A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. Results Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). Conclusion Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.

Association of Mesh and Fixation Options with Reoperation Risk after Laparoscopic Groin Hernia Surgery: A Swedish Hernia Registry Study of 25,190 Totally Extraperitoneal and Transabdominal Preperitoneal Repairs

“…14 Tissue-penetrating mesh fixation is a well-known cause of chronic postoperative pain. 18 , 53 Our findings indicate that avoiding tacks will not increase the overall reoperation risk. A tacker costs approximately $300 to $450 in the US.…”

“…Eventually, some randomized controlled trials (RCTs) suggested that the preperitoneal mesh position in itself renders fixation redundant, but this controversy is yet not settled. 13 - 18 …”

Clinical Data Analysis for Treatment of Adult Inguinal Hernia by TAPP or TEP

“…With the continuous development of laparoscopic surgery, the proportion of LIHR procedures has gradually increased, and LIHR has become an important surgical treatment for inguinal hernia ( 12 , 13 ). Compared with previous open tension-free repair operations, it has the advantages of a smaller incision, less pain, and a quicker return to normal activities ( 14 – 19 ).…”

Inguinodynia after inguinal hernioplasty - clinical and surgical management: a literature review

“…The inferolateral margin of the mesh is sutured to the border of the iliopubic tract or shelf of the inguinal ligament to a point lateral to the internal inguinal ring. At this point, the ends created by the opening are sutured together around the spermatic cord [21][22][23][24]. Factors in the popularization of the Lichtenstein technique in comparison with the laparoscopic techniques are its ease of execution with fewer serious complications and the possibility of performing the operation under local anesthesia [12].…”

“…Almost all the meshes used are made of polypropylene, polyester or polytetrafluoroethylene [30]. Of these three, polypropylene is the most common [22][23][24]. This material may be related to the incidence of inguinodynia, since the reaction it causes with the tissue makes it rigid and inelastic.…”