title: [Comparison between two different mesh fixation methods in laparoscopic inguinal hernia repair: tacker vs. Synthetic cyanoacrylate glue.]
abstract: OBJECTIVE
  The aim of this retrospective study was to compare the results of two different mesh fixation methods in laparoscopic transabdominal preperitoneal hernioplasty (TAPP): tacker vs. synthetic cyanoacrylate glue.
  
  
  METHODS
  The study group includes 70 patients with bilateral and monolateral recurrent inguinal hernia undergoing transabdominal preperitoneal repair (TAPP) in the period 2011-2013. A polypropylene mesh was fixed in group A (N.=35) with titanium tacks (EndoUniversal stapler, Covidien) or in group B (N.=35) with synthetic cyanoacrylate glue (Glubran-2, GEM). Patient outcome was assessed by the following variables: sex, mean age, ASA score, intra- and postoperative morbidity, hospitalization, postoperative acute and chronic pain, recurrence rate. The observation period was 24 months, with a mean follow-up of 10.5 months (range, 1-23) for Group A and 11 months (range, 2-24) for Group B.
  
  
  RESULTS
  No difference between the two groups was observed with respect to mean operative time and hospitalization. In all cases, surgery was successfully concluded laparoscopically. Intraoperative complications occurred in 1 patient of the group A and consisted of a urinary bladder injury, which was immediately sutured. Postoperative complication rate was 5.7% (4 patients, of whom 3 in group A and 1 in group B). In each group we detected one recurrence within 6 (group A) and 18 months (group B) postsurgery; both patients were treated with a re-TAPP. Postoperative pain at 6 months from surgery, measured by visual analogue score (VAS), was reported by 4 patients in the group A and in no case of the group B (P=0.04).
  
  
  CONCLUSIONS
  Data from this study demonstrate the advantages of synthetic cyanoacrylate glue for mesh fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair, compared to titanium tacks. The use of this surgical glue was associated with a significantly reduced risk for developing chronic groin pain and a shortened hospital stay. Nevertheless, further studies with longer follow-up periods are needed to confirm our encouraging results.
authors.affiliation: Unità Operativa di Chirurgia Generale Colonproctologica, Dipartimento di Scienze Chirurgiche Azienda Ospedaliera S. Giovanni ‑ Addolorata, Roma, Italia - francescostipa@yahoo.it.
authors.forename: A
authors.initials: A
authors.lastname: Burza
authors.forename: R
authors.initials: R
authors.lastname: Avantifiori
authors.forename: R
authors.initials: R
authors.lastname: Curinga
authors.forename: E
authors.initials: E
authors.lastname: Santini
authors.forename: P
authors.initials: P
authors.lastname: Delle Site
authors.forename: F
authors.initials: F
authors.lastname: Stipa