The Glubran 2 glue for mesh fixation in Lichtenstein's hernia repair: a double-blind randomized study.

Abstract

IntroductionWith an average incidence rate of 11%, chronic pain is considered the most serious complication of inguinal hernioplasty after surgical site infection. One of the proposed solutions to this problem is to use tissue adhesive for mesh fixation, which helps prevent nerve and tissue damage.AimThe goal of this study was to compare mesh fixation with the use of sutures vs. adhesive in Lichtenstein's inguinal hernia repair in a randomized, double-blind one-center study.Material and methodsThe study group consisted of 41 males with primary inguinal hernia undergoing Lichtenstein's repair (20 – adhesive; 21 – suture) and remaining in follow-up from July 2008 to November 2010. Randomization took place during the operation. The follow-up was performed by one surgeon (blinded) according to a pre-agreed schedule; the end-of-study unblinding was performed during the last follow-up visit, usually 16 months postoperatively.ResultsIn 1 patient from the “adhesive” group, a recurrence was observed one year after the initial repair. The early postoperative pain was less intense in this group. In later postoperative periods the method of mesh fixation had no influence on the pain experienced by the patient. Other complications were not correlated with the method of mesh fixation.ConclusionsIn this randomized, one-center double-blind clinical study of males with primary inguinal hernia it has been show during follow-up that the use of Glubran 2 cyanoacrylate adhesive for mesh implant fixation yields similar recurrence and chronic pain rates as the classical suture technique. In the early postoperative period, the pain reported by these patients was relatively weaker; patients undergoing adhesive mesh fixation experienced a quicker return to daily household activities.

Effect of mesh type, surgeon and selected patients' characteristics on the treatment of inguinal hernia with the Lichtenstein technique. Randomized trial.

“…In our study the patients returned to normal activities of daily living 5 days after surgery on average, which was consistent with results of similar studies (4-10 days on average) [11, 22]. The shorter return to normal activities of daily living and sport observed for our patients with LW mesh was also confirmed by published results from similar studies and meta-analyses that confirm the beneficial effect of light meshes [18, 21, 23, 32].…”

“…Moreover, our study shows that surgery by surgeon 2 significantly reduced procedure duration as compared to the other surgeons. The effect of the operator on surgery duration is a well-acknowledged fact confirmed by published study results [8, 11, 30, 31]. …”

“…Although tension-free surgical techniques for inguinal hernia repair have contributed to the improvement of the outcome as well as the marked reduction of hernia recurrence, these techniques are not free of complications [4, 6, 7, 9–11]. The most common and still unresolved clinical problem is the chronic pain in the operated groin.…”

“…For primary inguinal hernia repair however the most frequent treatment of choice is the open Lichtenstein method, which is relatively uncomplicated and highly effective for prevention of hernia recurrence [1, 2, 6–8]. Although implants of synthetic material have brought long awaited improvement in hernia management regardless of the method used and have reduced hernia recurrence to 1-2%, the tension-free techniques are not free of adverse effects [4, 6, 7, 9–11]. Chronic pain in the operated groin remains an unsolved clinical problem reported in about 11% of patients and in 8% of them pain intensity affects the quality of everyday life [12–14].…”

Single incision approach to totally extraperitoneal inguinal hernia repair.

“…Dąbrowiecki et al ., comparing fixation of the mesh during the Lichtenstein method, did not reveal significant differences in the postoperative pain between the adhesive and penetrating method [17]. The literature reports, comparing the classic TEP method with the TEP procedure performed with a single incision approach with a multiport or with the introduction of surgical instruments directly into the operative area, indicated no differences in postoperative pain, hospitalization time, and full patient convalescence.…”