Conventional Sutures versus Cyanoacrylate Glue in Mesh Fixation in Open Inguinal Hernioplasty

Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty. Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale. Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life. Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.

Background: inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become gold standard in open inguinal hernia repair. Despite the low recurrence rates; postoperative pain and discomfort remain a problem for a large number of patients. Aim of the work: the aim of this study is to compare between cyanoacrylate, sutureless and polypropylene sutures in mesh fixation on lichtenstein tension free in repair of open inguinal hernia regard as postoperative pain, infection, recurrence,& cost benefit. Methods: a total of thirty patients with primary unilateral uncomplicated inguinal hernia were randomized to undergo lichtenstein tension free hernioplasty, and were randomized using close envelope into three groups: Group A: Inguinal hernioplasty with mesh fixation using polypropylene sutures (10 patients), Group B: Inguinal hernioplasty with mesh fixation using cyanoacrylate glue (10 patients) and Group C: Inguinal hernioplasty with mesh placement without sutures (10 patients). Primary outcome was early and late postoperative pain. Secondary endpoints were use of painkillers after 24 hours, morbidity rate and recurrence rate. Follow-up time was 6 months. Results: significantly, less postoperative pain was reported in group B compared to the other two groups (A&C). Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay and earlier return to daily activities were seen in patients within group(B).Clinical recurrence was reported in only one patient in Group C after a period of four months follow up postoperatively. Conclusion: cyanoacrylate glue seemed to be a simple, original, reasonable, feasible, reproducible technique and competitive alternative to the standard tissue-penetrating meshfixation devices in open inguinal hernioplasty. It is accompanied by a reduction in chronic inguinal pain, with no increase in the early recurrence rate.

Open tension-free inguinal hernioplasty is one of the common surgical methods used today to treat inguinal hernias due to its simplicity and low recurrence rate. With the widespread use of tension-free inguinal hernia repair, the number of patients with mesh infections is gradually increasing. However, there is a lack of studies assessing the quality of life of patients after the removal of late-onset infected meshes in open inguinal hernias. The aim of this study was to analyse and assess the quality of life, pain severity and anxiety of patients after late-onset infection mesh removal following open inguinal hernioplasty. Data from 105 patients admitted to our hospital from January 2014 to January 2019 who developed delayed mesh infection after open tension-free inguinal hernia repair were retrospectively analysed. 507 patients without mesh infection after open inguinal hernioplasty were included as cross-sectional controls. The baseline data of the two groups were matched for propensity score matching (PSM) with a caliper value of 0.05 and a matching ratio of 1:1. Patients are followed up by telephone or outpatient consultations for 3years to assess quality of life, pain and anxiety after removal of the infected mesh. The 105 patients who developed late-onset mesh infection after inguinal hernia repair had a mean age of 64.07 ± 12.90years and a mean body mass index (BMI) of 24.64 ± 2.67 (kg/m2). The mean follow-up time was 58months and 10.5% (10/105) of the patients were lost to follow-up. At the 3-year follow-up there was one case of hernia recurrence and five cases of mesh reinfection. The patients' quality of life scores, pain scores and anxiety scores improved after surgery compared to the preoperative scores (all p < 0.01). Patients with late-onset mesh infection after inguinal hernioplasty showed an improvement in quality of life, pain and anxiety compared to preoperative after removal of the infected mesh. Mesh-plug have a higher risk of mesh infection due to their poor histocompatibility and tendency to crumple and shift.

Three different mesh fixation techniques were compared to find out how to perform a safe and cost-effective open inguinal hernioplasty in day-case setting with the best outcomes with regard to chronic pain. Mesh fixation method may influence on the incidence of chronic pain after Lichtenstein hernioplasty. Lichtenstein hernioplasty was performed under local anesthesia in 625 patients as day-case surgery in 8 Finnish hospitals. The patients were randomized to receive either a cyanoacrylate glue (Histoacryl, n = 216), self-gripping mesh (Parietex ProGrip, n = 202), or conventional nonabsorbable sutures (Prolene 2-0, n = 207) for mesh fixation. The incidence of wound complications, pain, recurrences, and patients discomfort was recorded on days 1, 7, 30, and 1 year after surgery. The primary endpoint was the sensation of pain measured by pain scores and the need of analgesics after 1 year of surgery. The type and size of inguinal hernias were similar in the 3 study groups. The duration of operation was 34 ± 13, 32 ± 9, and 38 ± 9 minutes in the glue, self-gripping, and suture groups, respectively (P < 0.001). There were no significant differences postoperatively in pain response or need for analgesics between the study groups. Two superficial infections (0.3%), 31 wound seromas (5.0%), and 4 recurrent hernias (0.6%) were recorded during a 1-year follow-up. Some 25 patients (4.2%) needed occasionally analgesics for chronic groin pain. A feeling of a foreign object and quality of life were similar in all study groups. This randomized trial failed to prove that mesh fixation without sutures causes less inguinodynia than suture fixation in Lichtenstein hernioplasty. Mesh fixation without sutures is feasible without compromising postoperative outcome.

Glue fixation of mesh has been explored for some time as a strategy for reducing postoperative chronic groin pain. Previous studies have come to different conclusions about the superiority of one method over another. We conducted a meta-analysis of randomized control trials comparing the performance of glue versus suture fixation of mesh in open inguinal hernioplasty. Studies published up to November 2012 were searched using PubMed, EMBASE, MEDLINE, Cochrane Library, and the international standard randomised controlled trials number (ISRCTN) register. Mean differences (MDs) were derived from secondary continuous outcomes and pooled risk ratios (RRs) for categoric outcomes. Meta-analysis was conducted utilizing the random-effects and fixed-effects models as appropriate. Ten randomized controlled studies were selected, with a total of 1,623 patients. Glue fixation for open inguinal hernioplasty reduced chronic groin pain (RR 0.46, 95 % confidence interval (CI) 0.22-0.97), hematoma (RR 0.56, 95 % CI 0.34-0.90), acute postoperative pain (MD -7.92, 95 % CI, -13.17 to -2.66), and time taken to return to normal activities (MD -1.39, 95 % CI, -2.58 to -0.21). There was no evidence of an increase in adverse outcomes including recurrence with glue fixation (RR 0.83, 95 % CI 0.30-2.35). Glue fixation of mesh for open inguinal hernioplasty is superior in many outcomes including the reduction of chronic groin pain. Glue fixation was not associated with an increased risk of hernia recurrence.

Background: In open anterior inguinal mesh hernioplasty, the commonly used method for mesh fixation is by polypropylene sutures which involves extensive mesh fixation and placement of sutures into periosteum of pubic symphysis, thereby increasing the operative time with attendant risk of infection of the prosthetic material. An alternative to sutures is the use of staples which are easy to use and quick to apply. We explored the use of staples in securing the mesh in inguinal hernioplasty. Methodology: A prospective comparative study of 400 patients who underwent inguinal mesh hernioplasty with 200 patients selected randomly each in polypropylene suture (PPSG) and staple group (SG) was performed. Postoperatively patients were made ambulatory on the same day of surgery and discharged from hospital on 1st or 2nd day in both the groups. Follow-up was carried out in 1 week, 2 months, 6 months, 1 year, 2 years, and 3 years and the patients were assessed for wound infection, hematomas, local pain, return to work, recurrence if any, and other miscellaneous complications if any. Results: The mean age of patients in our study in polypropylene suture group and staple group was 46.75 years and 46 years, respectively. 80% (160 patients) in polypropylene suture group and 75% (150 patients) in stapler group had indirect hernia. The mean operative time in PPSG and SG group was 59.25 minutes and 45 minutes, respectively (p value0.05). Overall the complication rate was the same in the two groups with no statistically significant differences observed (P value >0.05). There was 0% recurrence rate in 6 months and 1 year of follow-up in both groups. However, in 3-year follow-up 20 patients (10%) in PPSG and 2 patients (1%) in SG had recurrence (P value=0.0001). Conclusion: The technique of mesh fixation with skin staples is as effective as conventional fixation with polypropylene sutures, with an important added advantage of a significant reduction in the operative time and an early return to work. At the same time this technique does not have any additional complications compared to traditional Lichtenstein method. Good tissue penetrance and effective mesh anchorage are achieved when staples are utilized to secure the mesh.

Objective: To determine the outcome of Open and laparoscopic Inguinal Hernioplasty. Study Design: Comparative prospective study. Place and Duration of Study: Department of Surgery Combined Military Hospital, Multan Pakistan, from Sep 2021 to Oct 2022. Methodology: One hundred patients were enrolled and divided into Group-A and Group-B based on a technique used. Patents with a working diagnosis of inguinal hernia aged 13 to 90 years were included in the study. The data was collectedbfrom the participants at one week and six months post-operatively. Results: The mean age of patients was 43.87±13.63 years. The mean operative time was 70.5±10.48 minutes. The mean hospital stay was 1.88±0.79 days. The median post-op pain at 0 hours was 2(2 – 1); at 6 hours was 4(6 – 3); at 12 hours was 5(5 – 4) and at 24 hours was 5(6-3). Conclusion: The laparoscopic surgical technique is a wonderful addition to the surgical tool kit of a surgeon. When performed by experienced persons, there is speedy recovery and reduced hospital stay with minimal morbidity and mortality. It is highly recommended for inguinal hernioplasty.

Aim This work aimed to identify the outcomes of mesh fixation using cyanoacrylate in open inguinal hernia repair with regard to long-standing groin pain, operative time, rate of recurrence, degree of postoperative pain, and other complications. Patients and methods This was a prospective cross-sectional analytic study on 54 patients complaining of unilateral inguinal hernia that evaluated the usage of cyanoacrylate in open inguinal hernioplasty as a material for mesh fixation. The study was conducted in the General Surgery Department between November 2016 and February 2018. Male patients with denovo unilateral inguinal hernia suitable for elective open mesh repair were involved in the study and gave informed consent. Follow-up was carried out during a period ranging from 1 to 6 months. The primary outcome was early complications including early postoperative pain, bleeding, infection, seroma, and operative time. Secondary endpoints were long-standing groin pain and recurrence rate. Results About 48 cases of 54 (88.9%) needed less than 4 min for mesh fixation in open inguinal hernia repair. An overall 44% of cases have reported no early postoperative pain. Only 5.6% of cases have reported a status of chronic groin pain, and no cases have been reported for recurrence. Conclusion The results have led us to recommend the usage of cyanoacrylate for fixation of mesh in inguinal hernia repair to decrease the occurrence of postoperative complications in inguinal hernioplasty, generally, and the long-standing groin pain particularly, especially in patients who are more prone to experience pain.

Aim A randomized controlled study comparing the impact of fixation vs non-fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic groin pain and quality of life of patients. Patients and methods This study includes 100 patients presented with primary unilateral indirect inguinal hernia treated at Benha University Hospital from June 2016 to August 2018. Patients were randomized to TAPP inguinal hernia repair with fixation of mesh (group A, n=50) and without fixation of mesh (group B, n=50). Parameters assessed included operative duration, time to early ambulation, postoperative pain, and postoperative complications and quality of life. Assessment of pain was done using the visual analog scale at 1 day, 3 months, and 6 months after surgery. Evaluation of quality of life was done using the 36-item short-form health survey 3 months postoperatively. Results The mean operative duration and time to early ambulation in group B (without mesh fixation) were reduced significantly in comparison to group A (with mesh fixation). The visual analog scale score at 1 day, 3 months, and 6 months after surgery for group B was significantly lower than in group A. The physical function (PF), bodily pain (BP), role physical (RP), and general health (GH) in group B were significantly higher than group A while there is no statistically significant difference in vitality (VT), role emotional (RE), social function (SF), and mental health (MH) between group A and group B. Conclusion Mesh fixation and non-fixation in laparoscopic TAPP approach for the repair of inguinal hernia are comparable regarding operative duration, postoperative complications, and time to ambulation while pain scores and quality of life were significantly better in the non-fixation group.

The technique for fixation of mesh has been attributed to adverse patient and surgical outcomes. Although this has been the subject of vigorous debate in laparoscopic hernia repair, the several methods of fixation in open, anterior inguinal hernia repair have seldom been reviewed. The aim of this systematic review was to determine whether there is any difference in patient-based (recurrence, post-operative pain, SSI, quality of life) or surgical outcomes (operative time, length of operative stay) with different fixation methods in open anterior inguinal hernioplasty. A literature search was performed in PubMed, EMBASE and the Cochrane Library databases. Randomised clinical trials assessing more than one method of mesh fixation (or fixation versus no fixation) of mesh in adults (>18 years) in open, anterior inguinal hernia repair, with a minimum of 6-month follow-up and including at least one of the primary outcome measures (recurrence, chronic pain, surgical site infection) were included in the review. Secondary outcomes analysed included post-operative pain (within the first week), quality of life, operative time and length of hospital stay. Twelve randomised clinical trials, which included 1,992 primary inguinal hernia repairs, were eligible for inclusion. Four studies compared n-butyl-2 cyanoacrylate (NB2C) glues to sutures, two compared self-fixing meshes to sutures, four compared fibrin sealant to sutures, one compared tacks to sutures, and one compared absorbable sutures to non-absorbable sutures. The majority of the trials were rated as low or very low-quality studies. There was no significant difference in recurrence or surgical site infection rates between fixation methods. There was significant heterogeneity in the measurement of chronic pain. Three trials reported significantly lower rates of chronic pain with fibrin sealant or glue fixation compared to sutures. A further three studies reported lower pain rates within the first week with non-suture fixation techniques compared to suture fixation. A significant reduction in operative time, ranging form 6 to 17.9 min with non-suture fixation, was reported in five of the studies. Although infrequently measured, there were no significant differences in length of hospital stay or quality of life between fixation methods. There is insufficient evidence to promote fibrin sealant, self-fixing meshes or NB2C glues ahead of suture fixation. However, these products have been shown to be at least substantially equivalent, and moderate-quality RCTs have suggested that both fibrin sealant and NB2C glues may have a beneficial effect on reducing immediate post-operative pain and chronic pain in at-risk populations, such as younger active patients. It will ultimately be up to surgeons and health-care policy makers to decide whether based on the limited evidence these products represent a worthwhile cost for their patients.

Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive. to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes. Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months. There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups. Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs. All ethical approval was given by our Faculty of Medicine medical ethical committee.

Background: Inguinal hernia repair is one of the most commonly performed procedures by general surgeons. Cyanoacrylate is the generic name for a family of fast acting adhesives. The aim of the present study done in Department of General Surgery, Safdarjung Hospital, New Delhi was to compare the newer emerging technique of mesh fixation.Methods: A total of sixty patients were included in the present study and were allotted in case and control group randomly by sealed envelope technique. In case (study) group, all the patients underwent mesh fixation by cyanoacrylate glue and in control group, by prolene 3-0 sutures.Results: Most frequency in age group 31-40 yrs, males:females ratio &gt;1 and right sided inguinal hernia was more common. Bi-lateral hernia was common in elderly. Indirect: direct ratio 4.5:1. Operating time period for the patients of the case (study) group is less than control group. P value of post-operative pain in immediate post-operative period (day 1 and 2) and POD 30, 60 and 90 was not of clinical significance whereas the p-value on 6,120,150 and 180 post op day was of clinical significance. In our study, there was a case of incidental observation: a) reaction due to use of cyanoacrylate glue, b) rejection of mesh for which mesh had to be removed.Conclusions: There is no statistically significant difference between mesh fixation with cyanoacrylate glue and mesh fixation by prolene suture techniques in immediate post-operative pain. Statistically significant difference favoring mesh fixation by cyanoacrylate glue technique was seen with respect to operating time and post-operative groin pain with increasing post-operative duration.

Background: The occurrence of post-operative chronic pain after mesh hernioplasty in nonincisional ventral hernia is especially disturbing as it is felt by 0-43% of patients, 11% on average. Post-operative pain is the consequence of tissue dissection and post-operative local inflammation. As a result, the surrounding nerves become damaged and painful stimu-lation occurs. The cyanoacrylate glue, the characteristic of histoacryl such as efficacy, excellent local tolerability, and less of adverse effects makes it an optimal choice for the atraumatic mesh fixation. It has been used in a variety of surgical fields for its effectiveness, excellent local tolerability and relative lack of adverse effects and contraindications. However, the hospital costs were increased by the use of cyanoacrylate glue instead of the sutures.Aim of Study: The aim of this study is to evaluate the feasibility, efficacy of cyanoacrylate glue in mesh fixation in non-incisional ventral hernia repair as regard the operative time, the post-operative pain, the occurrence of wound seroma and recurrence rate.Patients and Methods: This prospective study was carried out on 20 patients of different ages in either sex presented with nonincisional ventral hernia who were subjected to mesh hernioplasty with cyanoacrylate glue. They were followed-up for chronic pain, seroma, recurrence.Results: The post-operative pain was evaluated in 1st month and at 6 months by visual analogue score, 8 out of 20 patients (40%) had mild pain and 2 out of 20 patients (10%) had moderate pain. Shrinkage of the mesh reported in 2 out of 20 patients (10%) and 5 out of 20 patients (25%) developed seroma over the mesh that resolved on conservative treatment. No recurrence of the hernia during the follow-up period by clinical examination and by abdominal ultrasound.Conclusion: The mesh fixation with cyanoacrylate glue in nonincisional ventral hernia is more expensive than using sutures in mesh fixation but, it can reduce the need for analgesics and improve life style by decreasing incidence of chronic post-operative pain. We recommend performing further studies with larger population.

Background: Inguinal hernia repair is one of the most common surgical procedures. While conventional sutures are widely used for mesh fixation, they can lead to increased postoperative pain and complications. Cyanoacrylate glue has emerged as a potential alternative for non-traumatic fixation. Objective: To compare the outcomes of mesh fixation using N-Hexyl cyanoacrylate glue versus conventional sutures in inguinal hernia repair. Methods: A prospective randomized comparative study was conducted with 100 patients divided into two groups: Group A (Glue) and Group B (Sutures). Parameters such as operation time, postoperative pain (VAS score), seroma formation, surgical site infection (SSI), hospital stay, and recurrence rates were evaluated. Results: The mean procedure time was significantly lower in the Glue group (65.86 ± 7.75 minutes) compared to the Sutures group (81.12 ± 9.50 minutes; p &lt; 0.0001). Postoperative pain (VAS scores) was lower in the Glue group on days 3, 5, and 8. Seroma and SSI rates were reduced in the Glue group. Recurrence rates at 6 months were also lower for the Glue group (0%) compared to Sutures (6%; p = 0.04). Conclusion: Cyanoacrylate glue is a safe and effective alternative for mesh fixation in inguinal hernia repair, offering reduced operation time, pain, and complications.

The aim of this study was to compare the effect of transabdominal preperitoneal (TAPP) inguinal hernioplasty with or without mesh fixation on chronic pain and quality of life of patients. One hundred patients with a simple oblique inguinal hernia were included and treated at the Second Affiliated Hospital of Kunming Medical University from July of 2015 to July of 2016. Patients were randomly assigned to TAPP inguinal hernioplasty with mesh fixation (fixation group, n = 50) or without mesh fixation (non-fixation group, n = 50). Observation indices such as mean operative time, time to ambulation, hospitalization expense, and complications were recorded. The visual analog scale (VAS) was adopted for pain evaluation 2days, 3months, and 6months postoperatively. The 36-item short-form health survey (SF-36) was adopted for life quality scoring 3months postoperatively. No recurrence or incisional infections were observed during follow-up in either group. The mean operative time, time to ambulation, and hospitalization expense of the non-fixation group were all significantly reduced compared to those of the fixation group. The VAS score 2days, 3months, and 6months postoperatively of the non-fixation group were significantly lower than in the fixation group. The physical function, role physical, bodily pain, and general health in the non-fixation group were each significantly higher than in the fixation group. In contrast, vitality, social function, role emotional, and mental health showed no significant differences across groups. For patients with primary unilateral oblique inguinal hernia with a defect size less than 4.0cm in diameter, TAPP inguinal hernioplasty without mesh fixation was safe and effective. Furthermore, this shortened the operative time, promoted early ambulation, decreased hospitalization expenses, alleviated postoperative pain, and improved quality of life.