Laparoscopic Injection of Tissue Adhesives for Inguinal Hernia Repair in a Rabbit Model: Results of an Experimental Comparative Study with the Standard Laparoscopic Inguinal Hernia Repair

Abstract

Background: The injection of tissue adhesives has been proposed as an alternative to standard laparoscopic inguinal hernia repair but no evidence is available in the pediatric population. This study aimed to evaluate safety, efficacy, and feasibility of injection of tissue adhesives for inguinal hernia repair in a rabbit model. Materials and Methods: Thirty-six New Zealand White male rabbits underwent laparoscopic inguinal hernia repair. In each animal, the hernia defect was repaired using glue on the right side and purse-string suture on the left side. The animals were divided in 3 groups, each 1 of 12 animals, according to the glue used: Glubran 2 (cyanoacrylate), Histoacryl (cyanoacrylate), and BioGlue (bovine serum albumin-based). For each group, 6 animals were sacrificed at 7 days postoperatively, and 6 animals at 90 days postoperatively. Histopathological exam of testis and spermatic bundle was performed. Results: The hernia defect was successfully closed on both sides in all cases. The injection of glue was faster than suture repair (P = .001). Postoperative complications (epiploonparietal adhesions, spermatic vessel ectasia, and hydrocele) rate was significantly higher on the right side compared to the left side at both short-and longterm follow-up (P = .001). Furthermore, a lower maturity of testicles treated by adhesive compared with suture was histologically demonstrated at both short-and long-term follow-up (P = .001). Conclusions: The present experimental study confirmed the feasibility and efficacy of inguinal hernia repair by injection of tissue adhesive. However, several critical issues emerged about the safety of this technique. The use of glue was associated with higher incidence of postoperative complications and significant decrease of testicular maturity compared with standard suture repair. Based upon these preliminary results, repair using suture remains the standard of care for inguinal hernia in children. Further experimental studies are needed to assess the safety of injection of tissue adhesives for pediatric inguinal hernia repair.

Comparison of Surgical Outcomes of Laparoscopic Glue and Laparoscopic Suture Hernioplasty in Pediatric Female Inguinal Hernia

“…Recently, Maria et al published a comparative study on the laparoscopic injection of tissue adhesives and standard laparoscopic suture inguinal hernia repair in a male rabbit model. The authors describe several critical issues that are associated with a higher incidence of postoperative complications and a significant decrease in testicular maturity in tissue adhesive models [43].…”

The laparoscopic repair of inguinal hernia in female children in the Republic of North Macedonia

“…It is believed that the sex of the child, girls as opposed to boys, has a slight influence on the incidence of metachronous hernia (boys 6.05% as opposed to girls 6.59%; r=0.202) [24,25].…”

Progress of tissue adhesives based on proteins and synthetic polymers

“…Albumin-based TAs are used to seal pulmonary air leaks [ 87 ] and to perform nephron-sparing [ 88 ], cardiac [ 89 ], nasal septal [ 90 ], proximal aortic [ 81 ], splenic [ 91 ], and inguinal hernia surgeries [ 92 ]. However, these TAs cannot control active bleeding; therefore, they can be used to adhere only to a bloodless area.…”