A systematic review and meta-analysis was conducted to compare the effect of mechanical mesh fixation in laparoscopic inguinal hernia repair against glue-based mesh fixation. The primary outcome was the effect of the two techniques on chronic postoperative inguinal pain, defined as pain or discomfort persisting for 3 months as per European Hernia Society guidelines. The rate of hernia recurrence, acute pain and occurrence of postoperative complications such as hematoma and seroma and quality of life (QoL) were selected as the secondary outcome measures. The review included 15 randomized-controlled trials published between 2005 and 2016 that compared mechanical with glue-based fixation in adult patients (aged over 18 years) on chronic pain and were published in the English language between 2005 and 2016. These trials included participants from Europe, Asia, Australia and the United States. Other trials that compared self-adhesive mesh fixation, non-inguinal hernia or open hernia repair, included non-comparative or non-randomized trials were not considered for the review. A total of 2777 hernias among 2109 patients were evaluated. All pooled analyses were computed using a random-effects model.

It was found that the use of glue-based mesh fixation reduced the incidence of chronic pain (risk ratio (RR) 0.36, 95% CI 0.19 to 0.69; p = 0.002). Postoperative hematomas also reduced following glue-based mesh fixation (RR 0.29, 0.10 to 0.82; p = 0.02). The incidence of seroma formation and hernia recurrence rates on follow up were comparable between the two groups. The meta-analysis concluded that the incidence of chronic postoperative inguinal pain and hematoma after laparoscopic inguinal hernia repair was lower with glue-based mesh fixation. The two groups also showed comparable recurrence rates. Looking to the inconsistencies in the studies with regard to QOL measures, the definition of chronic pain, the authors recommend introduction of a core outcome set relevant to hernia repair to improve quality of reporting of outcomes.

Habib Bedwani N, et al. Br J Surg. 2021 Jan 27;108(1):14-23.