Cyanoacrylate mesh fixation for laparoscopic inguinal hernia repair: a prospective, multicenter, single-arm study

Abstract

Background Inguinal hernia repair is among the most frequently performed surgical procedures. Alternatives to penetrating mesh fixation, such as surgical glue, are being investigated for their potential benefit in reducing chronic pain. The aim of this study was to assess the efficacy of the n-hexyl cyanoacrylate glue Ifabond (TM) for mesh fixation in laparoscopic inguinal hernia repair.Methods This prospective, multicenter, single-arm study collected data from laparoscopic inguinal hernia repairs using Ifabond (TM) (Peters Surgical, Boulogne-Billancourt Cedex, France) and a standard [Promesh (R) SURG ST (Peters Surgical)/Biomesh (R) P1 (Cousin Biotech, Wervicq-Sud, France)] or lightweight [Promesh (R) SURG LI (Peters Surgical)/Premium (R) Implant (Cousin Biotech)] polypropylene mesh. The primary endpoint was postoperative pain [100-scale Visual Analog Scale (VAS)]. Secondary endpoints were complications, hernia recurrences, and quality of life (QoL) (EQ-5D-3L health index and EQ-VAS). Patients were followed up at 5 weeks and 12 months after surgery.Results Six-hundred and thirteen patients underwent laparoscopic inguinal hernia repair. Postoperative pain decreased at 5-week (3.97 +/- 10.04; p < 0.0001) and 12-month (3.83 +/- 11.26; p < 0.0001) follow-up compared with before surgery (26.96 +/- 19.42). One hundred and fifteen patients (13.74%) experienced chronic pain in the groin at 12-month follow-up, of whom 14 (2.67%) required analgesics. There were 6 patients with major morbidities and one patient died of an unrelated cause. Two hernia recurrences occurred within 12-month follow-up. Patients' QoL increased from an EQ-5D-3L index score of 0.82 +/- 0.19 preoperatively to 0.90 +/- 0.15 at 5 weeks (p < 0.0001) and 0.92 +/- 0.15 at 12 months after surgery (p < 0.0001). The EQ-VAS general health scoring increased from 79.03 +/- 12.69 preoperatively to 84.31 +/- 9.97 at 5-week (p < 0.0001) and 84.16 +/- 14.48 at 12-month follow-up (p < 0.0001).Conclusions Ifabond (TM) (Peters Surgical) is a safe, reliable, and feasible fixation method for laparoscopic inguinal hernia repair with a very high surgeon satisfaction score, improved patients' QoL, and comparable risk of developing chronic pain and postoperative complications as described in the literature.