Fibrin Glue Mesh Fixation (GMF) Vs Sutures Mesh Fixation (SMF) In Human Open Inguinal Hernia Repair (OIHR): Surgically and Histologically

Background: The Lichtenstein technique; suture mesh fixation is widely used for the open inguinal hernia repair (OIHR) as it is easy to learn and is associated with a low rate of complications and recurrences. However, recently, some studies have clarified that this technique is inferior to some ‘sutureless' repair systems in terms of perceived difficulty, operating time, postoperative pain, patient satisfaction, etc. Methods: We employed a fibrin glue mesh fixation in 30 patients (group A) and sutures mesh fixation using vicryl in 30 patients (group B). All the patients included in this study were male and aged between 17 and 60 years old with exclusion of recurrent, obstructed and strangulated hernia. Histologically, at the end of the Fibrin Glue Mesh Fixation, small pieces from the mesh fixed with Posterior wall of the inguinal canal; conjoint tendon were taken for the histological studies. The specimens were fixed immediately in neutral buffered formalin 10%, dehydrated, cleared and processed for paraffin blocks and 5 micron thick sections were obtained, mounted on a glass slides and stained histologically with Hematoxylin & Eosin (H&E) and Green Masson's Trichrome. Results: The mean operating time was ranged from 30 to 45 minutes in a fibrin glue mesh fixation (group A) and from 40 to 60 minutes in a suture mesh fixation (group B). All patients received spinal anesthesia and discharged home 24 h after the operation and none required readmission to hospital. There were no intra operative complications. No sepsis, mesh rejection or other complications such as haematoma or seroma were recorded at 14-day follow-up. Regarding the postoperative pain, patients of group A were returned to their normal activity from 10 days to 2 weeks after operation with better satisfaction. Meanwhile, patients of group B take more time from 2 weeks to 6 weeks for returning to normal activity with less satisfaction. Histologically, with H&E and Green Masson's Trichrome stains, colorless spherical structures of the posterior wall of the inguinal canal-conjoint tendon were observed. Meanwhile, under polarized light, the brightly birefringent were observed filling these colorless structures. Furthermore, with Green Masson's Trichrome stain, massive wavy fibrin threads forming bundles were observed filling all the spaces in between the polypropylene threads of mesh fixing the later with the surrounding tissues. Moreover, numerous fibroblasts were observed in between the fibrin bundles which distributed in different directions. Conclusion: The present investigation clarify that the use of fibrin glue is better than sutures in tension free inguinal hernia repair using mesh technique. Moreover, there is less operative time, post-operative pain, with better patient satisfaction and early return to normal activities in group A using fibrin glue mesh fixation in inguinal hernia repair.