Comparison of Staple Fixation Versus N-butyl-2- cyanoacrylate Fixation in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: A Randomized Controlled Trial
Keywords:
Inguinal hernia, Laparoscopic, TEP, Mesh fixation, Chronic painAbstract
Background : In totally extraperitoneal laparoscopic inguinal hernia repair (TEP), it is accepted that mesh fixation is necessary to prevent mesh displacement and hernia recurrence. However, fixation by using staples may cause complications, such as pubic injury and nerve entrapment, leading to chronic pain.
Objective : To compare the use of staples with that of N-butyl-2-cyanoacrylate glue in mesh fixation of TEP inguinal hernia repair.
Method : A randomized controlled trial was conducted during June 2015- 2017. Sixty patients with TEP were allocated into two groups, 30 patients in staple group (Protack) and 30 patients in the glue group (Histoacryl). Data collected included demographic data, operative time, postoperative pain (mumerical rating scale), chronic pain, complications and recurrence.
Results : Numerical rating scale (NRS) in the staple group was significantly greater than that of the glue group after 12 hours (1.97±0.85 vs 1.20±1.19, p=0.006) and 48 hours (1.65±0.89 vs 0.93±0.96, p=0.006).The incidence of chronic pain was higher in the staple group at three months (16.7% vs 13.3%, p=0.424) and six months (6.7% vs 3.3%, p=0.353). Demographic data and complications showed no significant difference between the two groups. Hernia recurrence was not found in either group after six months follow-up.
Conclusions : N-butyl- 2-cyanoacrylate glue might be an alternative choice of mesh fixation in TEP due to satisfactory outcomes and complications were not different compared to staple fixation.
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