Randomized clinical trial of tissue glue versus absorbable sutures for mesh fixation in local anaesthetic Lichtenstein hernia repair

Background: Chronic pain may be a long-term problem related to mesh fixation and operative trauma after Lichtenstein hernioplasty. The aim of this study was to compare the feasibility and safety of tissue cyanoacrylate glue versus absorbable sutures for mesh fixation in Lichtenstein hernioplasty. Methods: Lichtenstein hernioplasty was performed under local anaesthesia as a day-case operation in one of three hospitals. The patients were randomized to receive either absorbable polyglycolic acid 3/0 sutures (Dexon (R); 151 hernias) or 1 ml butyl-2-cyanoacrylate tissue glue (Glubran (R); 151 hernias) for fixation of lightweight mesh (Optilene (R)). Wound complications, pain, discomfort and recurrence were identified at 1 and 7 days, 1 month and 1 year after surgery. Results: A total of 302 patients were included in the study. The mean(s.d.) duration of operation was 34(12) min in the glue group and 36(13) min in the suture group (P = 0.113). The need for analgesics was similar during the first 24 h after surgery. Five wound infections (3.4 per cent) were detected in the glue group and two (1.4 per cent) in the suture group (P = 0.448). The recurrence rate at 1 year was 1.4 per cent in each group (P = 1.000). The rates of foreign body sensation, acute and chronic pain were similar in the two groups. Logistic regression analysis showed that the type of mesh fixation did not predict chronic pain 1 year after surgery. Conclusion: Mesh fixation without sutures in Lichtenstein hernioplasty was feasible without compromising postoperative outcome. Registration number: NCT00659542 (http://www.clinicaltrials.gov).