World Journal of Surgery

, Volume 38, Issue 10, pp 2558–2570 | Cite as

Mesh Fixation at Laparoscopic Inguinal Hernia Repair: A Meta-Analysis Comparing Tissue Glue and Tack Fixation

  • Nehal S. Shah
  • Catherine Fullwood
  • Ajith K. Siriwardena
  • Aali J. SheenEmail author



The aim of this study was to conduct a comprehensive systematic review comparing tissue glue (TG) against tacks/staples for mesh fixation in laparoscopic (totally extra-peritoneal and trans-abdominal pre-peritoneal) groin hernia repair with the incidence of post-operative chronic pain as the primary outcome measure.


A computerized search of MEDLINE, EMBASE, and Cochrane databases for the period from 1 January 1,990 to 30 June 2013 produced 39 reports. The quality of reports was assessed according to criteria reported by the Cochrane communication review group.


Five randomized controlled trials (RCTs, 491 patients) and five non-RCTs (1,034 patients) fulfilled the selection criteria. A meta-analysis of chronic pain from the five RCTs gave a statistically significant Peto odds ratio (OR) of 0.40 (0.21–0.76; p = 0.005) indicating that the TG group experience less chronic pain. Although the studies are underpowered to detect recurrence, the meta-analysis of the recurrence rates from the RCTs identified no difference between tacks/staple and glue fixation (OR 2.36; 0.67–8.37). There were also no differences found in meta-analysis of seroma and hematoma formation between the two methods of fixation. The wide variation in time points regarding pain score meant it was not possible to combine the studies and perform analysis for pain score with earlier time points.


Meta-analysis of RCTs comparing TG with tack fixation in laparoscopic inguinal hernia surgery depicts a significant reduction in chronic pain with no increase in recurrence rates. Early post-operative outcome is similar after both methods of mesh fixation, although larger RCTs are required, with long-term pain as the primary endpoint.


Chronic Pain Fibrin Glue Fibrin Sealant Mesh Fixation Seroma Formation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

None of the authors have any known conflicts of interest (financial, professional, or personal) in relation to this work.

Financial support

The service of a medical writer (ME Appleyard) was funded by Baxter Healthcare Limited.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Nehal S. Shah
    • 1
  • Catherine Fullwood
    • 2
  • Ajith K. Siriwardena
    • 1
  • Aali J. Sheen
    • 1
    Email author
  1. 1.Department of Surgery, Manchester Royal InfirmaryUniversity of ManchesterManchesterUK
  2. 2.Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, NIHR Manchester Biomedical Research CentreThe University of ManchesterManchesterUK

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