Use of cyanoacrylate adhesive for fixation of mesh and peritoneum in transabdominal preperitoneal laparoscopic inguinal hernia repair

Abstract

Introduction: Inguinal hernia surgery is among the most commonly performed operations in general surgery. Standard surgical approaches include open or laparoscopic techniques with various mesh fixation methods: tissue-perforating fixation devices, adhesives, or non-fixation techniques. The European Hernia Society (EHS) guidelines indicate that adhesives for mesh fixation and peritoneal closure can reduce both acute and chronic postoperative pain compared to tissue-perforating fixation methods.

Material and method: Between February 1, 2023, and August 31, 2023, we prospectively monitored 20 male patients divided into two equal groups: Group I (GI) underwent transabdominal preperitoneal (TAPP) procedure with mesh and peritoneum closure using absorbable tacks, while Group II (GII) underwent TAPP procedure with mesh and peritoneum closure using n-butyl-2-cyanoacrylate (NBCA) adhesive. Both groups received light polypropylene titanium mesh (10×15 cm). Postoperative analgesia protocols were identical for all patients. We evaluated the technical success of mesh and peritoneum fixation, postoperative pain using a visual analog scale (VAS), and early complications including hematomas, wound infections, and hernia recurrence. Follow-up assessments were performed on postoperative days 1, 6, and 30. Statistical analysis employed standard descriptive statistics, one and two-factor analysis of variance, multiple range tests, median Mood test, and Tukey test.

Results: The average patient age was 53.7 years with no significant differences between groups. During the 30-day follow-up period, no recurrent hernias, wound infections, or hematomas were observed in either group. Mesh fixation and peritoneal closure were successfully achieved in all cases across both groups. Two-factor analysis of variance showed no statistically significant difference in overall pain scores between the groups. However, Group II (adhesive) demonstrated significantly faster pain reduction over time. By postoperative day 6, patients in Group II reported pain levels equivalent to those reported by Group I patients at day 30 (VAS 0.8). Multiple range tests confirmed that the adhesive technique resulted in significantly more rapid pain reduction compared to the tack fixation method.

Conclusion: The n-butyl-2-cyanoacrylate adhesive technique represents a safe, effective method for mesh fixation and peritoneal closure in TAPP hernia repair. This approach provides superior results in preventing and reducing postoperative pain compared to tissue-perforating fixation techniques, potentially leading to faster recovery and improved patient outcomes.