title: Open tension-free Lichtenstein repair of inguinal hernia: use of fibrin glue versus sutures for mesh fixation.
abstract: OBJECTIVE
  To investigate pain and other complications following inguinal hernioplasty performed by the Lichtenstein technique with mesh fixation by fibrin glue or sutures.
  
  
  METHODS
  Five hundred and twenty patients were enrolled in this 12-month observational multicenter study and received either sutures or fibrin glue (Tissucol(®)/Tisseel(®)) based on the preference of the surgeon. Pain, numbness, discomfort, recurrence, and other complications were assessed postoperatively and at 1, 3, 6, and 12 months. Pain intensity was assessed by a visual analog scale (VAS; 0 [no pain] to 10 [worst pain]).
  
  
  RESULTS
  One hundred and seventy-one patients received sutures and 349 received fibrin glue. During the early postoperative phase, 87.4% of patients in the fibrin glue group and 76.6% of patients in the sutures group were complication-free (P = 0.001). Patients who received fibrin glue were also less likely to experience hematoma/ecchymosis than those in the suture group (both P = 0.001). The mean pain score was significantly lower in the fibrin group than the sutures group (2.5 vs. 3.2, P < 0.001). At 1 month, significantly fewer patients in the fibrin glue group reported pain, numbness, and discomfort compared with patients in the sutures group (all P < 0.05). Fibrin glue patients also experienced less intense pain (0.6 vs. 1.2; P = 0.001). By 3 months, the between-group differences had disappeared, except for numbness, which was more prevalent in the sutures group. By 12 months, very few patients reported complications.
  
  
  CONCLUSIONS
  Tissucol fibrin glue for mesh fixation in the Lichtenstein repair of inguinal hernia shows advantages over sutures, including lower incidence of complications such as pain, numbness, and discomfort, and should be considered as a first-line option for mesh fixation in hernioplasty.
authors.affiliation: Azienda Ospedaliera Università degli Studi di Roma La Sapienza, Rome, Italy. pal.negro@libero.it
authors.forename: P
authors.initials: P
authors.lastname: Negro
authors.forename: F
authors.initials: F
authors.lastname: Basile
authors.forename: A
authors.initials: A
authors.lastname: Brescia
authors.forename: G M
authors.initials: GM
authors.lastname: Buonanno
authors.forename: G
authors.initials: G
authors.lastname: Campanelli
authors.forename: S
authors.initials: S
authors.lastname: Canonico
authors.forename: M
authors.initials: M
authors.lastname: Cavalli
authors.forename: G
authors.initials: G
authors.lastname: Corrado
authors.forename: G
authors.initials: G
authors.lastname: Coscarella
authors.forename: N
authors.initials: N
authors.lastname: Di Lorenzo
authors.forename: E
authors.initials: E
authors.lastname: Falletto
authors.forename: L
authors.initials: L
authors.lastname: Fei
authors.forename: M
authors.initials: M
authors.lastname: Francucci
authors.forename: C
authors.initials: C
authors.lastname: Fronticelli Baldelli
authors.forename: A L
authors.initials: AL
authors.lastname: Gaspari
authors.forename: E
authors.initials: E
authors.lastname: Gianetta
authors.forename: A
authors.initials: A
authors.lastname: Marvaso
authors.forename: P
authors.initials: P
authors.lastname: Palumbo
authors.forename: N
authors.initials: N
authors.lastname: Pellegrino
authors.forename: R
authors.initials: R
authors.lastname: Piazzai
authors.forename: P F
authors.initials: PF
authors.lastname: Salvi
authors.forename: C
authors.initials: C
authors.lastname: Stabilini
authors.forename: G
authors.initials: G
authors.lastname: Zanghì
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects* / Q000627:therapeutic use; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D012008:Recurrence; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D013537:Sutures / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive