title: Randomized Multicenter Trial Comparing Glue Fixation, Self-gripping Mesh, and Suture Fixation of Mesh in Lichtenstein Hernia Repair (FinnMesh Study).
abstract: OBJECTIVE
  Three different mesh fixation techniques were compared to find out how to perform a safe and cost-effective open inguinal hernioplasty in day-case setting with the best outcomes with regard to chronic pain.
  
  
  BACKGROUND
  Mesh fixation method may influence on the incidence of chronic pain after Lichtenstein hernioplasty.
  
  
  METHODS
  Lichtenstein hernioplasty was performed under local anesthesia in 625 patients as day-case surgery in 8 Finnish hospitals. The patients were randomized to receive either a cyanoacrylate glue (Histoacryl, n = 216), self-gripping mesh (Parietex ProGrip, n = 202), or conventional nonabsorbable sutures (Prolene 2-0, n = 207) for mesh fixation. The incidence of wound complications, pain, recurrences, and patients discomfort was recorded on days 1, 7, 30, and 1 year after surgery. The primary endpoint was the sensation of pain measured by pain scores and the need of analgesics after 1 year of surgery.
  
  
  RESULTS
  The type and size of inguinal hernias were similar in the 3 study groups. The duration of operation was 34 ± 13, 32 ± 9, and 38 ± 9 minutes in the glue, self-gripping, and suture groups, respectively (P < 0.001). There were no significant differences postoperatively in pain response or need for analgesics between the study groups. Two superficial infections (0.3%), 31 wound seromas (5.0%), and 4 recurrent hernias (0.6%) were recorded during a 1-year follow-up. Some 25 patients (4.2%) needed occasionally analgesics for chronic groin pain. A feeling of a foreign object and quality of life were similar in all study groups.
  
  
  CONCLUSIONS
  This randomized trial failed to prove that mesh fixation without sutures causes less inguinodynia than suture fixation in Lichtenstein hernioplasty. Mesh fixation without sutures is feasible without compromising postoperative outcome.
authors.affiliation: *Kuopio University Hospital, Kuopio, Finland †Helsinki University Hospital, Helsinki, Finland ‡Päijät-Häme Central Hospital, Lahti, Finland §North-Karelia Central Hospital, Joensuu, Finland ¶Mikkeli Central Hospital, Mikkeli, Finland ||Savonlinna Central Hospital, Savonlinna, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Rönkä
authors.forename: Jaana
authors.initials: J
authors.lastname: Vironen
authors.forename: Jyrki
authors.initials: J
authors.lastname: Kössi
authors.forename: Tanja
authors.initials: T
authors.lastname: Hulmi
authors.forename: Seppo
authors.initials: S
authors.lastname: Silvasti
authors.forename: Tapio
authors.initials: T
authors.lastname: Hakala
authors.forename: Imre
authors.initials: I
authors.lastname: Ilves
authors.forename: Indrek
authors.initials: I
authors.lastname: Song
authors.forename: Merja
authors.initials: M
authors.lastname: Hertsi
authors.forename: Petri
authors.initials: P
authors.lastname: Juvonen
authors.forename: Hannu
authors.initials: H
authors.lastname: Paajanen
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000517:prevention & control; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D014014:Tissue Adhesives