Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate: long-term biocompatibility in over 1,300 mesh fixations

Abstract

IntroductionIn adult patients, most inguinal hernias are treated by implanting a prosthetic mesh. To prevent mesh dislocation and thus recurrence, different types of fixation have been proposed. In contrast to penetrating fixation known to cause acute chronic pain, adhesive fixation is becoming increasingly popular as it reduces markedly the risk of injury and chronic pain. Apart from the biological sealants (e.g., fibrin glue), surgical adhesives include a group of synthetic glues and genetically engineered protein glues. For example, cyanoacrylate is used in various medical and veterinary indications due to its fast action, excellent bonding strength and low price.ObjectiveThe main objective of this paper was to communicate positive results obtained using n-butyl-cyanoacrylate glue to fix prosthetic meshes in over 1,300 TAPP repairs of primary and recurrent inguinal hernias. The secondary objective was to highlight the rationale (e.g., safety) for using non-fibrin based glue in this type of procedure.MethodWe present the in vitro and in vivo data necessary for the approval of n-butyl cyanoacrylate Histoacryl® glue. We use an equivalent glue, Glubran-2®, to fix prosthetic meshes in 1,336 laparoscopic TAPP repairs.ResultsStandardized tests to detect sensitization, irritation, genotoxicity or systemic toxicity demonstrated the safety and biocompatibility of Histoacryl®, which met all requirements, including those of ISO 10993. Histological long-term studies in rabbits yielded results comparable to routine suture fixations, with full integration of the mesh into the abdominal wall. The clinical results showed the following advantages: fast application of the glue, reduced postoperative pain, 0.0% infection rate, continuously low recurrence rate and shorter hospital stay. No adverse effects and no complaints were recorded.ConclusionThe experimental and clinical data demonstrate the safe use and the excellent cost-benefit ratio of n-butyl cyanoacrylate compared with other techniques of mesh fixation.

Cyanoacrylic tissue glues: Biochemical properties and their usage in urology

“…[22,50] Besides, their use for the obliteration of processus vaginalis during hydrocelectomy has been also reported. [9][10][11][12] Their use with mesh In an experimental trial, Kukleta et al [13] performed mesh fixation in rabbits with CA glue -nBCA (Histoacryl ® ), and did not observe a reaction in muscle tissue during the acute phase. They reported fibroblastic tissue reaction characterized by mildly or moderately inflammatory cells.…”

“…Their study demonstrated suitability of using tissue adhesives as the first alternative based on comparative assessments of benefit, and economic burden. [13] Application of cyanoacrylate tissue adhesives Devices are available for superficial, vesical, intraureteral, intraurethral, tissue, intravascular, and laparoscopic applications. Figure 4 shows shows application devices.…”

“…[9][10][11][12] If basic principles are obeyed safe use of nBCA for external, and internal applications has been demonstrated both in preclinical, and clinical studies. [13] Cyanoacrylic glues ensure high degree, and strong bonding to biologic tissues when compared with other adhesives. CAs have short (methyl-2 or ethyl-2), and long-chain (nbutyl-2, and n-octyl-2) forms.…”

Comparison of four chondral repair techniques in the hip joint: a biomechanical study using a physiological human cadaveric model

“…The fourth technique (cyanoacrylate repair) is not currently reported in literature, although cyanoacrylate has been used extensively in other fields of surgery 27,37,38 . The repair of a cartilage flap using fibrin glue is ideal, since it is fast, relatively inexpensive and can be carried out arthroscopically 12,15 .…”

“…Orthopaedic research with cyanoacrylates is limited to skin closure, tendon and meniscal repair 42e44 . The safety of Glubran 2™ for internal use has been extensively reported in gastrointestinal surgery 27,38 , so far however, there are no reports in the literature describing its use for chondral repair. Nbutyl-2-cyanoacrylate is a liquid compound that polymerizes rapidly in the presence of hydroxyl ions.…”