title: Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Fixation of mesh is typically performed to minimize risk of recurrence in laparoscopic inguinal hernia repair. Mesh fixation with staples has been implicated as a cause of chronic inguinal pain. Our study aim is to compare mesh fixation using a fibrin sealant versus staple fixation in laparoscopic inguinal hernia and compare outcomes for hernia recurrence and chronic inguinal pain.
  
  
  METHODS
  PubMed was searched through December 2010 by use of specific search terms. Inclusion criteria were laparoscopic total extraperitoneal repair inguinal hernia repair, and comparison of both mesh fibrin glue fixation and mesh staple fixation. Primary outcomes were inguinal hernia recurrence and chronic inguinal pain. Secondary outcomes were operative time, seroma formation, hospital stay, and time to return to normal activity. Pooled odds ratios (OR) were calculated assuming random-effects models.
  
  
  RESULTS
  Four studies were included in the review. A total of 662 repairs were included, of which 394 were mesh fixed by staples or tacks, versus 268 with mesh fixed by fibrin glue. There was no difference in inguinal hernia recurrence with fixation of mesh by staples/tacks versus fibrin glue [OR 2.13; 95% confidence interval (CI) 0.60-7.63]. Chronic inguinal pain (at 3 months) incidence was significantly higher with staple/tack fixation (OR 3.25; 95% CI 1.62-6.49). There was no significant difference in operative time, seroma formation, hospital stay, or time to return to normal activities.
  
  
  CONCLUSIONS
  The meta-analysis does not show an advantage of staple fixation of mesh over fibrin glue fixation in laparoscopic total extraperitoneal inguinal hernia repair. Because fibrin glue mesh fixation with laparoscopic inguinal hernia repair achieves similar hernia recurrence rates compared with staple/tack fixation, but decreased incidence of chronic inguinal pain, it may be the preferred technique.
authors.affiliation: Minimally Invasive Surgery Training & Innovation Center (MISTIC), Department of Surgery, Johns Hopkins University School of Medicine, MISTIC/Blalock 1222, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Kaul
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Hamilton
authors.initials: H
authors.lastname: Le
authors.forename: Senan A
authors.initials: SA
authors.lastname: Hamed
authors.forename: Kevin
authors.initials: K
authors.lastname: Tymitz
authors.forename: Hien
authors.initials: H
authors.lastname: Nguyen
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marohn
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D059350:Chronic Pain / Q000209:etiology; D003365:Costs and Cost Analysis; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D017792:Surgical Stapling / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D015718:Fibrin Tissue Adhesive