Mesh fixation with fibrin glue versus tacker in laparoscopic totally extraperitoneal inguinal hernia repair

Glue versus tackers for mesh fixation in laparoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis

PURPOSE

Mesh fixation in laparoscopic inguinal hernia repair has improved patient outcomes compared to natural tissue repair. The method of fixation of the mesh to the abdominal wall and its impact on patient outcomes has not been determined as part of a trial sequential analysis. The aim of this study is to compare the use of glue and tackers in mesh fixation of inguinal and femoral hernia repair by meta-analysis and trial sequential analysis (TSA).

METHOD

Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched to retrieve relevant randomised controlled trials (RCT) comparing glue and tacker fixation in laparoscopic inguinal and femoral hernia repair, resulting in 648 studies, of which 18 met the inclusion criteria. This data was systematically analysed using RevMan and TSA software.

RESULTS

2312 patients were included in the 18 RCTs used in this study, with 1149 in the glue cohort and 1163 in the tacker cohort. Glue fixation significantly reduced risk of haematoma formation [MD (95% CI): 0.35 (0.17-0.73), P < 0.01]. Glue fixation resulted in significantly less acute pain [MD (95% CI): - 1.80 (- 2.71 to - 0.89), P < 0.01] and chronic pain [MD (95% CI): 0.42 (0.27-0.64), P < 0.01]. Glue fixation also allowed significantly quicker return to normal activity/work compared to tacker fixation [MD (95% CI): - 1.92 (- 3.17 to - 0.67), P < 0.01]. TSA confirmed that glue fixation significantly reduced early pain scores (< 3 months) and haematoma incidence compared to tacker fixation.

CONCLUSION

Mesh fixation with glue is superior to tackers in reducing post-operative pain and haematomas, which means patients return to work/activity significantly faster. Surgeons should be aware of these benefits when consenting the patient for laparoscopic inguinal and femoral hernia repair.

Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy

Background

This analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF.

Methods

PubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords "Glue mesh repair," "Tack mesh repair," "Inguinal Hernia," "Herniorrhaphy," "Laparoscopic," "Mesh Fixation," and "Randomized controlled trials."

Results

In this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: -1.07, (-1.90, -0.25)]. We also used funnel plots and Egger's regression to test for publication bias.

Conclusion

In summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.

Efficacy and safety of glue mesh fixation for laparoscopic inguinal hernia: A meta-analysis of randomized controlled trials

It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P < 0.00001], urinary retention[RR = 0.53, 95% CI(0.29,0.97), P = 0.04], haematoma[RR = 0.23, 95% CI(0.09,0.58), P = 0.002] and total complications[RR = 0.28, 95% CI(0.18,0.44), P < 0.00001]; there were no significant differences in pain score on postoperative day 1[MD = -1.33, 95% CI(-2.93,0.26), P = 0.10], operation time[MD = 1.46, 95% CI(-3.97,6.88), P = 0.60] and recurrence rate[RR = 0.72, 95% CI(0.35,1.47), P = 0.37] between the two groups. In conclusion, the application of glue mesh fixation in laparoscopic inguinal hernia repair is safe and reliable with fewer complications. Moreover, it can reduce the incidence of chronic pain without increasing the recurrence rate. However, due to the small number of cases in this analysis and limitations in the quality of the included studies, the findings need to be further verified by multicentre, large-sample and high-quality RCTs in the future.

Seroma-prevention strategies in minimally invasive inguinal hernia repair

BACKGROUND:

The rise of minimally invasive inguinal hernia repair has seen both the laparoscopic and robotic approaches increase in popularity in recent years. Despite this, seroma formation remains a common complication, and the aim of this study is to evaluate the current evidence on seroma-prevention strategies in minimally invasive inguinal hernia repair.

MATERIALS AND METHODS:

Four databases (PubMed, Scopus, Embase, and Cochrane Library) were searched from inception to November 15, 2021. All studies describing the use of intraoperative adjuncts to reduce postoperative seroma formation in patients undergoing laparoscopic or robotic inguinal and inguinoscrotal hernia repair were included. Meta-analyses were performed using Review Manager (Version 5.4).

RESULTS:

2,382 articles were identified in the initial database search, and 40 articles were included in the final analysis. In this analysis, there was a significantly lower incidence of seroma formation in the drain group when compared to the no-drain group (P < 0.00001). Other strategies aimed at reducing the dead space involving the transversalis fascia (TF) and hernia sac such as TF inversion with tacking, Endoloop closure of TF, barbed suture closure of TF, distal sac fixation, and complete dissection of the sac have shown promising results as well.

CONCLUSIONS:

While there is currently insufficient evidence to recommend the routine use of any one of the interventions analyzed, the use of drains, the management of the TF, and the hernia sac have showed potential in reducing seroma formation.