Five reasons not to use glue fixation in lap inguinal hernia repair.
Learn questions surgeons are asking on the real value of glue in inguinal hernia repair.
How easy is it to use compared to mechanical fixation? How fiddly is it to put together and reload? For the cynoacrylate, how easy is it to remove once set if the sheer force is said to be greater than some mechanical fixation devices?
There is a pool of evidence seeking to prove better pain scores with glue than mechanical fixation. A number of comparative studies show no difference in pain at 3 months and higher recurrence at 2 years. If pain scores are the same and recurrence rates are higher, is this a good trade-off?
What is the impact of non-absorbable glue on tissue integration? If the glue is not absorbable is it creating a long-term barrier between the mesh and abdominal wall reducing or even eliminating the ability for tissue integration into the mesh?
It is well known cynoacrylates cause an exothermic reaction when setting. The quicker they set, the more heat they generate. Surgeons question: "What impact might the heat of the exothermic reaction have on the underlying structures?"
How much does glue cost? Compared to mechanical fixation biologics are generally more expensive; the new fixation devices are at least the same price; and others maybe less but require multiple devices and applicators, particularly for a bilateral hernia.
References: 1. Voice of Customer. 2. Heniford, T. etal. A prospective, long-term, multicenter evaluation of mesh fixation with glue vs absorbable tacks in laparoscopic inguinal hernia repair (LIHR) – impact on recurrence and quality of Life (QOL). Hernia (2015) (Suppl2): S3-S159-S160. 3. K. Horisberger etal, Influence of Type of Mesh Fixation in Endoscopic Totally Extraperitoneal Hernia Repair (TEP) on Long-term Quality of Life. World J Surg (2013) 37:1249–1257. 4. Martin I. etal. A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs.International Journal of Surgery 17 (2015) 79e82. 5. LiquibandFix Product Brochure.
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