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A comprehensive study comparing tack and glue mesh fixation in laparoscopic total extraperitoneal repair for adult groin hernias

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Abstract

Background

Glue mesh fixation is thought to cause less pain compared to tack mesh fixation during laparoscopic total extraperitoneal inguinal hernia repair (TEP). However, the clinical benefits of glue mesh fixation are still controversial. This study aimed to evaluate the acute pain, chronic pain, and recurrence rate between these two fixation methods.

Methods

After reviewing all patients in our prospective hernia repair database from February 2008 to December 2017, we identified 583 patients who underwent TEP with tack mesh fixation and 70 patients with glue fixation by a single surgeon. Acute post-operative pain and activity level were evaluated using a Visual Analog Score (VAS) and the modified Medical Outcome Study (MOS) score. The primary endpoint was chronic pain 6 months after TEP. The secondary endpoints were acute pain, activity level, complications, and recurrence.

Results

After adjustment for potential confounding factors, the glue mesh fixation had significant lower VAS at 2 h post operation during rest and coughing and on the first day after surgery during coughing (p = 0.005, p < 0.001, and p = 0.011). The modified MOS on the first day was higher in the glue group (p < 0.001). There were no reduced risk of chronic pain or increased risk of recurrence for the glue group compared to the tack group [Odds ratio (OR) = 0.237, p = 0.169; OR = 2.498, p = 0.299]. In the sub-group analysis for recurrent hernia repair, glue fixation is associated with better modified MOS (p = 0.031) on first day and lower VAS on the operative day and first day at rest (p = 0.003 and p = 0.024) after surgery.

Conclusions

Glue fixation method was superior to tack fixation method in acute post-operative pain and early post-operative activity level after laparoscopic TEP repair. However, both fixation methods had similar incidence of chronic pain-, recurrence-, and procedure-related complications after laparoscopic TEP repair.

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Author notes

  1. Chi-Wen Lo and Yao-Chou Tsai Contributed equally to the work.

Authors and Affiliations

  1. Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan

    Chih-Chin Yu, Chi-Wen Lo & Yao-Chou Tsai

  2. Department of Urology, Tzu Chi University, Hualien, Taiwan

    Chih-Chin Yu & Yao-Chou Tsai

  3. Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan

    Yung-Tai Chen

  4. Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

    Ching-Shui Huang

  5. Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Shih-Chieh J. Chueh

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  1. Chih-Chin Yu
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Correspondence to Chi-Wen Lo or Yao-Chou Tsai.

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Dr. Chih-Chin Yu, Ching-Shui Huang, Yung-Tai Chen, Shih-Chieh Jeff Chueh, Chi-Wen Lo, and Yao-Chou Tsai have no conflicts of interest or financial ties to disclose.

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Yu, CC., Chen, YT., Huang, CS. et al. A comprehensive study comparing tack and glue mesh fixation in laparoscopic total extraperitoneal repair for adult groin hernias. Surg Endosc 34, 4486–4493 (2020). https://doi.org/10.1007/s00464-019-07234-7

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  • DOI: https://doi.org/10.1007/s00464-019-07234-7

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