title: Glue versus suture fixation of mesh during open repair of inguinal hernias: a systematic review and meta-analysis.
abstract: BACKGROUND
  Glue fixation of mesh has been explored for some time as a strategy for reducing postoperative chronic groin pain. Previous studies have come to different conclusions about the superiority of one method over another. We conducted a meta-analysis of randomized control trials comparing the performance of glue versus suture fixation of mesh in open inguinal hernioplasty.
  
  
  METHODS
  Studies published up to November 2012 were searched using PubMed, EMBASE, MEDLINE, Cochrane Library, and the international standard randomised controlled trials number (ISRCTN) register. Mean differences (MDs) were derived from secondary continuous outcomes and pooled risk ratios (RRs) for categoric outcomes. Meta-analysis was conducted utilizing the random-effects and fixed-effects models as appropriate.
  
  
  RESULTS
  Ten randomized controlled studies were selected, with a total of 1,623 patients. Glue fixation for open inguinal hernioplasty reduced chronic groin pain (RR 0.46, 95 % confidence interval (CI) 0.22-0.97), hematoma (RR 0.56, 95 % CI 0.34-0.90), acute postoperative pain (MD -7.92, 95 % CI, -13.17 to -2.66), and time taken to return to normal activities (MD -1.39, 95 % CI, -2.58 to -0.21). There was no evidence of an increase in adverse outcomes including recurrence with glue fixation (RR 0.83, 95 % CI 0.30-2.35).
  
  
  CONCLUSIONS
  Glue fixation of mesh for open inguinal hernioplasty is superior in many outcomes including the reduction of chronic groin pain. Glue fixation was not associated with an increased risk of hernia recurrence.
authors.affiliation: Department of Colorectal Surgery, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK. hcolvin@doctors.org.uk
authors.forename: Hugh Shunsuke
authors.initials: HS
authors.lastname: Colvin
authors.forename: Ahsan
authors.initials: A
authors.lastname: Rao
authors.forename: Marta
authors.initials: M
authors.lastname: Cavali
authors.forename: Giampiero
authors.initials: G
authors.lastname: Campanelli
authors.forename: Amin Ibrahim
authors.initials: AI
authors.lastname: Amin
mesh_terms: D059350:Chronic Pain / Q000517:prevention & control; D006552:Hernia, Inguinal / Q000517:prevention & control / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015233:Models, Statistical; D016017:Odds Ratio; D010149:Postoperative Pain / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D055502:Secondary Prevention; D013526:Surgical Mesh; D013537:Sutures; D014014:Tissue Adhesives; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives