Evaluation of Cyanoacrylate Glue in Mesh Fixation in Non-Incisional Ventral Hernia

Abstract
Background: The occurrence of post-operative chronic pain after mesh hernioplasty in nonincisional ventral hernia is especially disturbing as it is felt by 0-43% of patients, 11% on average. Post-operative pain is the consequence of tissue dissection and post-operative local inflammation. As a result, the surrounding nerves become damaged and painful stimu-lation occurs. The cyanoacrylate glue, the characteristic of histoacryl such as efficacy, excellent local tolerability, and less of adverse effects makes it an optimal choice for the atraumatic mesh fixation. It has been used in a variety of surgical fields for its effectiveness, excellent local tolerability and relative lack of adverse effects and contraindications. However, the hospital costs were increased by the use of cyanoacrylate glue instead of the sutures.
Aim of Study: The aim of this study is to evaluate the feasibility, efficacy of cyanoacrylate glue in mesh fixation in non-incisional ventral hernia repair as regard the operative time, the post-operative pain, the occurrence of wound seroma and recurrence rate.
Patients and Methods: This prospective study was carried out on 20 patients of different ages in either sex presented with nonincisional ventral hernia who were subjected to mesh hernioplasty with cyanoacrylate glue. They were followed-up for chronic pain, seroma, recurrence.
Results: The post-operative pain was evaluated in 1st month and at 6 months by visual analogue score, 8 out of 20 patients (40%) had mild pain and 2 out of 20 patients (10%) had moderate pain. Shrinkage of the mesh reported in 2 out of 20 patients (10%) and 5 out of 20 patients (25%) developed seroma over the mesh that resolved on conservative treatment. No recurrence of the hernia during the follow-up period by clinical examination and by abdominal ultrasound.
Conclusion: The mesh fixation with cyanoacrylate glue in nonincisional ventral hernia is more expensive than using sutures in mesh fixation but, it can reduce the need for analgesics and improve life style by decreasing incidence of chronic post-operative pain. We recommend performing further studies with larger population.