title: Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair.
abstract: BACKGROUND
  Evidence for open groin hernia repair demonstrates less pain with bioglue mesh fixation compared with invasive methods. This study aimed to assess the short- and long-term effects of laparoscopic groin hernia repair with noninvasive and invasive mesh fixation.
  
  
  METHODS
  A systematic review of MEDLINE, CENTRAL, and OpenGrey was undertaken. Randomized trials assessing the outcome of laparoscopic groin hernia repair with invasive and noninvasive fixation methods were considered for data synthesis. Nine trials encompassing 1,454 patients subjected to laparoscopic hernia repair with mesh fixation using biologic or biosynthetic glue were identified. Short-term data were inadequate for data synthesis. Chronic pain was less frequently reported by patients subjected to repair with biologic glue fixation than with penetrating methods (odds ratio .46, 95% confidence interval .22 to .93). Duration of surgery, incidence of seroma/hematoma, morbidity, and recurrence were similar.
  
  
  CONCLUSIONS
  Laparoscopic groin hernia repair with bioglue mesh fixation was associated with a reduced incidence of chronic pain compared with mechanical fixation, without increasing morbidity or recurrence. Longer term data on recurrence are necessary.
authors: Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany; Department of General Surgery, University Hospital of Heraklion, Crete, Greece. Electronic address: stavros.antoniou@hotmail.com.
authors: Stavros A
authors: SA
authors: Antoniou
authors: Department of General Surgery, Sisters of Charity Hospital, Linz, Austria.
authors: Gernot
authors: G
authors: Köhler
authors: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors: George A
authors: GA
authors: Antoniou
authors: Department of Surgery, AZ Maria Middelares, Ghent, Belgium.
authors: Filip E
authors: FE
authors: Muysoms
authors: Department of General Surgery, Hospital Zell am See, Zell am See, Austria.
authors: Rudolph
authors: R
authors: Pointner
authors: Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany.
authors: Frank-Alexander
authors: FA
authors: Granderath
mesh_terms: D059350:Chronic Pain / Q000209:etiology / Q000517:prevention & control; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D015233:Models, Statistical; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013526:Surgical Mesh; D014014:Tissue Adhesives; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives
keywords: Biologic glue; Cyanoacrylate glue; Fibrin glue; Fibrin sealant; Groin hernia; Mesh fixation