A review of 35 randomised trials involving 4,329 adults found little to no difference between non-penetrating (glue or self-adhesive) and penetrating (tacks, staples, sutures) mesh fixation methods in laparoscopic groin hernia repair for chronic pain, recurrence, or most complications.
- 35 studies compared glue/self-adhesive mesh versus tacks/staples/sutures for fixing mesh during laparoscopic hernia repair
- No meaningful difference found in chronic pain risk, hernia recurrence, or most complications between the two methods
- Evidence quality was very low due to study design limitations and small sample sizes
How this compares to prior research
Before this review, surgeons debated whether non-penetrating fixation (glue or self-adhesive mesh) would reduce chronic pain compared to penetrating methods (tacks, staples, sutures), since penetrating devices could theoretically damage nerves. Conversely, some believed penetrating fixation might better prevent hernia recurrence by securing the mesh more firmly. This systematic review was conducted to resolve these uncertainties by pooling data from multiple randomised trials.
Hernia prevalence trends, global population, 1990–1999
Key findings
- Non-penetrating fixation (glue or self-adhesive mesh) showed no clear advantage over penetrating fixation (tacks, staples, sutures) for preventing chronic pain or hernia recurrence
- Non-penetrating methods may slightly reduce acute pain levels and haematoma risk, but the evidence is very uncertain
- Both fixation methods had similar rates of mesh infection, serious vascular events, and operative time
What this means in practice
- Ask your surgeon about their preferred mesh fixation method, as current evidence shows no clear winner between glue and tacks for most outcomes
- Consider that both fixation methods appear similarly safe regarding chronic pain and recurrence based on available studies
- Note that if you develop complications after hernia repair, the fixation method used may not be the primary factor
Frequently asked questions
What is mesh fixation in hernia repair?
During laparoscopic hernia surgery, surgeons place a mesh patch over the hernia defect and secure it using either penetrating methods (tacks, staples, sutures) or non-penetrating methods (glue or self-adhesive mesh).
Does the fixation method affect chronic pain after hernia surgery?
This review of 35 studies found little to no difference in chronic pain risk between glue/self-adhesive mesh and tacks/staples/sutures, though the evidence quality was very low.
Which fixation method prevents hernia recurrence better?
The review found no clear difference in recurrence rates between non-penetrating and penetrating fixation methods, but the evidence is very uncertain due to study limitations.
Key terms explained
Laparoscopic groin hernia repair
Minimally invasive surgery using small incisions and a camera to fix hernias in the groin area with mesh.
Non-penetrating mesh fixation
Securing surgical mesh using glue or self-adhesive materials that do not pierce through tissue layers.
Haematoma
A collection of blood outside blood vessels, forming a bruise or swelling after surgery.
Source: Penetrating versus non-penetrating mesh fixation in laparoscopic groin hernia repair. · DOI: doi: 10.1002/14651858.CD016122.pub2