“a Prospective Comparison of Tacks and Glue for Mesh Fixation in Laparoscopic Repair of Inguinal Hernia”

Francesco Stipa, MD PhD FACS, Valentina Giaccaglia, MD, Alessio Pigazzi, MD FACS, Ettore Santini, MD, Antonio Burza, MD. Department of Surgery, San Giovanni Hospital, Rome, Italy

Background. Chronic pain after laparoscopic repair of inguinal hernia is relatively common and may be invalidating. This is often due to nerve injury by penetrating mesh fixation devices. In several studies on open hernioplasty, atraumatic mesh fixation proved to be efficient. The aim of this study was to compare the effect on pain, complications and recurrence rate of two laparoscopic mesh fixation: with tacks (T) or with glue (G), to define whether one technique is superior.

Methods. Between January 2010 and September 2011 we operated on 40 patients either with bilateral or recurrent inguinal hernia, performing laparoscopic transabdominal preperitoneal repair (TAPP) and polypropylene mesh fixation either with titanium taks (ProTack, Covidien; group T, n=20) or synthetic glue (Glubran-2, GEM; group G, n=20). The mean follow up was 9 months.

Results. Postoperative pain measured by visual analogue score (VAS) in the T and G groups were respectively: 4.5 vs 3.2 on day 1, 2.9 vs 2.1 on day 2 and 0.7 and 0.3 on day 7. We did not experience postoperative complications in both groups except one bleeding from trocar site on group G which resolved spontaneously. Mean hospital stay was 1.5 days. Four patients (20%) in group T complained about chronic pain, whereas no patients in group G complained it. We had no recurrences at 1, 2, 6 and 9 months follow-ups in both groups.

Conclusions. In our experience atraumatic mesh fixation with synthetic glue significantly reduces postoperative and chronic pain with the same recurrence rate compared to taks fixation. A longer follow up is necessary to confirm these results over a longer period of time. Atraumatic mesh fixation with glue for TAPP may become the standard in the future.

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