Glue-based mesh fixation bests mechanical fixation for postoperative inguinal pain: Study

Mesh fixation in laparoscopic inguinal hernia repair (LIHR) remains highly debated, being largely influenced by individual-surgeon preferences. Non-penetrative methods of mesh fixation using tissue glue have been used for LIHR, and been associated with improved postoperative and chronic pain. Two meta-analyses conducted up to 2011 and 2013, both including five RCTs, demonstrated a significantly reduced risk of chronic pain with no increase in recurrence rate with use of fibrin glue versus penetrative fixation in LIHR. A systematic review comparing fibrin glue and cyanoacrylate showed no difference between glue subtypes in recurrence rates or postoperative complications.

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.

Regarding the study design,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. 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.

The primary outcome measure was CPIP, defined as pain or discomfort lasting 3 months as defined by European Hernia Society (EHS) guidelines. Secondary outcome measures included recurrence rates, postoperative haematoma and seroma formation, acute pain, and quality of life (QoL).

Data analysis revealed the following facts.

• 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).

For the full article follow the link: https://doi.org/10.1093/bjs/znaa002

Primary source: British Journal of Surgery