The application of n-butyl-2-cyanoacrylate (NBCA) medical adhesive for IPOM mesh fixation in subcostal hernia repair: a retrospective study.

Abstract

<h4>Background</h4>Subcostal hernia is a type of lateral abdominal wall hernia that usually occurs after open hepatobiliary or esophagogastric operations. The complex composition of different myofascial layers makes the anatomic reconstruction of the abdominal wall difficult. This study aims to evaluate the efficacy and safety of chemical medical adhesive in fixing the mesh during laparoscopic subcostal hernioplasty compared to sutures.<h4>Methods</h4>From Jan 2016 to Dec 2021, the data of 109 patients who underwent laparoscopic intraperitoneal onlay mesh (IPOM) repair for subcostal hernia were retrospectively analyzed. Patients were divided into two groups. In the glue group (n = 60), mesh fixation was achieved using a combination of n-butyl-2-cyanoacrylate (NBCA) medical adhesive (applied as a spray for the supracostal region) and absorbable tacks (for the subcostal region). In the suture group (n = 49), fixation was accomplished with a combination of simple-loose polypropylene sutures (supracostal region) and absorbable tacks (subcostal region). Operative characteristics, perioperative parameters, and postoperative outcomes were analyzed statistically.<h4>Results</h4>No differences between the two groups were observed concerning demographic characteristics and operation features such as defect size and mesh size used for operation. In the follow-up period, there were no differences between the two groups in recurrence or other complications, such as acute/chronic pain, seroma/hematoma, postoperative ileus, or surgical-site infection. Notably, the glue group exhibited a significantly shorter operative time compared with the suture group (83.6 ± 31.5 min vs. 101.2 ± 35.4 min, P = 0.007).<h4>Conclusion</h4>The application of NBCA medical adhesive for mesh fixation during IPOM repair of subcostal hernia is associated with shortened operative time. This technique is characterized by convenience, safety, and efficacy, thus supporting its further promotion as an alternative for mesh fixation.