[Is sutureless hernia repair a safe option for treating abdominal wall hernias? A prospective study with a synthetic tissue adhesive (n-hexyl-alpha-cyanoacrylate)].

INTRODUCTION

The use of tissue adhesives can be an alternative to suture fixation of the mesh, but experience in their use is very limited.

MATERIAL AND METHODS

A prospective descriptive study was conducted on a group of 35 patients with inguinal hernias repaired by sutureless hernioplasty (20 by open and 15 by endoscopic), the prosthesis was fixed with a synthetic adhesive (n-hexyl-α-cyanoacrylate). This group was compared with another 35 patients for hernia repair with fixation sutures. All patients were scheduled for outpatient surgery. Peri-operative variables were recorded. The patients were followed up at one week, one month, 6 months and one year after surgery.

RESULTS

There was no morbidity associated with the use of tissue adhesive (bruising, infection or skin necrosis). During a median follow-up of 15 months, no complications or recurrences were detected. In the open hernioplasty using adhesive significantly reduced surgery time (30 min versus 70 min, P=.001), postoperative pain (from 2.4 to 4.5 at one week, P<.001) and analgesic consumption (7 to 14 days, P<.001). In the laparoscopic approach are demonstrated significant differences in favour of the adhesive in pain (P=.001 at 24h), and in analgesic use (P<.001) was observed using the laparoscopic approach. The adhesive did not alter the morbidity or the relapse rate at one year in any of the two approaches, and the financial analysis showed an annual savings of 117,461.2 euros (about 460 hernias).

CONCLUSION

The use of a synthetic tissue adhesive (n-hexyl-α-cyanoacrylate) is safe as a means of fixation in uncomplicated hernia and patients without comorbidity, and with good postoperative results.