Comparison Of N-butyl 2-cyanoacrylate Glue Fixation Versus Conventional Fixation of Polypropylene Mesh In Patients Undergoing Lichtenstein Repair For Inguinal Hernia: A Randomized Control Trial.

Inguinal hernia is a prevalent surgical issue, affecting 3-8% of the global population, with a lifetime risk of 25% in males and 3% in females. It involves a weakness in the abdominal wall, allowing the protrusion of intra-abdominal contents. Inguinal hernias account for 75% of all hernias, with two-thirds being indirect (through the inguinal canal) and the rest direct (through Hesselbach’s triangle). Historically, various methods have been developed for hernia repair, starting with the strengthening of the external ring and anterior wall by Stormayr in 1559, Purman in 1692, and Czerny in 1877. The Bassini repair in 1887 focused on reconstructing the posterior wall, which was later modified by Shouldice in the 1940s to include four layers of fascia and aponeurosis for added strength.

The most recent and widely used method is the Lichtenstein repair, introduced in 1984 and modified in the 1990s, which uses a polypropylene mesh for tension-free onlay open mesh hernioplasty. However, mesh fixation with prolene suture can lead to complications such as seroma or hematoma formation, increased surgery duration, urinary retention, transient testicular pain and swelling, scrotal edema, infection, post-operative pain (inguinodynia), and rarely, recurrence. Chronic pain can be neuropathic, due to direct nerve damage, perineural fibrosis, or damage from staples, tacks, or suture materials, or non-neuropathic, due to folded mesh, periosteal reaction, or scar tissue formation.

To mitigate these complications, alternative methods for mesh fixation have been developed, including absorbable and non-absorbable tacks, cyanoacrylate or fibrin glues, bovine and porcine gelatin, PEG polymer, bovine albumin cross-linked with glutaraldehyde, lightweight and self-gripping mesh, and laparoscopic fixation, which has been found to reduce post-operative pain due to fewer fixation points. These advancements aim to improve patient outcomes and reduce complications in inguinal hernia repair.

JUSTIFICATION:

Several previous studies have demonstrated that patients in the N butyl 2 cyanoacrylate glue group experienced significantly less postoperative groin pain and shorter surgery duration compared to the Conventional suture group.(7) However, there is a lack of similar studies and awareness regarding the use of glue for mesh fixation in central India population. Therefore, this study aims to compare the efficacy of n butyl 2 cyanoacrylate glue for mesh fixation with conventional mesh fixation in central India group of population.