Fibrin glue versus staple mesh fixation in single-port laparoscopic totally extraperitoneal inguinal hernia repair: A propensity score-matched analysis

Background: Mesh fixation minimizes the risk of recurrence following laparoscopic inguinal hernia repair. Mesh fixation using staples has been implicated as a cause of chronic inguinal pain. We investigated whether fibrin glue mesh fixation reduces acute or chronic postoperative pain in patients undergoing single-port laparoscopic totally extraperitoneal inguinal hernia repair (SP TEP). Methods: Inguinal hernia patients undergoing SP TEP between October 2013 and September 2016 were evaluated. Propensity score matching was performed to compare short-term and chronic pain in patients undergoing mesh fixation involving either staples or fibrin glue. Results: Stapling was performed in 82 patients and 78 underwent fibrin glue mesh fixation; these individuals were balanced into 50 pairs. Immediately after surgery, the fibrin glue group required significantly less analgesia than did the staple group (p = 0.023). Otherwise, no significant between-group differences in postoperative pain scores or analgesia requirements were noted during the initial 7 postoperative days. Activities of daily living (ADLs) resumed earlier in patients undergoing fibrin glue mesh fixation, compared with staples (p = 0.016). At 6 months, no significant differences in the incidence of chronic pain were observed. Conclusions: The short-term outcomes of SP TEP were comparable regardless of the mesh fixation method, but the immediate postoperative analgesia requirement was significantly less for those in the fibrin glue group. The time to resume ADLs was shorter for the fibrin glue group. Fibrin glue for mesh fixation during SP TEP may be an efficacious alternative to stapling during minimally invasive inguinal hernia repair.