Multicentric pragmatic randomized controlled trial of mesh fixation system in primary and recurrent ventral hernia repair
In brief
Cyanoacrylate mesh fixation halves peri-operative complications and trims surgery time by about seven minutes
In a pragmatic trial of 214 ventral hernia repairs, glue-based fixation did not change chronic pain rates but independently reduced peri-operative complications by roughly 50% and shortened operating time by seven minutes, with a small drop in discharge pain. Benefits were most evident in laparoscopic cases, while open surgery showed no difference.
- Journal
- Updates in surgery (Q1)
- Published
- 7 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Francesco Prete, Giuseppe Massimiliano De Luca, Francesco Vittore, Alessandro Pasculli, Luigi Marano, Giuseppe Carbotta, et al.
- PMID
- 42704599
- DOI
- 10.1007/s13304-026-02817-1
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 13 September 2026): Not related to bariatric surgery outcomes
- Picked for Surgery (top studies of the week, 13 September 2026): Cyanoacrylate mesh fixation reduces peri‑operative complications
- Picked for Surgical Oncology (top studies of the week, 13 September 2026): Pragmatic RCT of mesh fixation in ventral hernia repair
Abstract
Controversy persists regarding the ideal type of fixation for hernia mesh. Transfixing methods have been linked to tissue trauma and to the development of chronic pain. In ventral hernia repair (VHR), retrospective studies showed a potential for fixation with cyanoacrylate of being as effective as conventional suture or tacks methods but with less postoperative pain and complications. A pragmatic randomized trial was conducted on patients undergoing primary and incisional VHR, analyzing mesh fixation by cyanoacrylate (experimental group) versus sutures or reabsorbable tacks (control group), stratifying a priori by laparoscopic(LVHR) and open approach(OVHR) to account for distinct anatomical and biomechanical environments. Primary outcome was chronic postoperative pain. Secondary outcomes were postoperative complications, recurrence, operating time, intraoperative blood loss, pain during admission. Univariable and multivariable analysis were conducted. Two hundred fourteen patients were included, of which 109 treated laparoscopically. Overall chronic pain occurred exclusively within the open surgery cohort (12/105 cases, 11.4%), with no statistical difference between fixation arms. Cyanoacrylate for mesh fixation was independent factor for fewer perioperative complications (OR 0.457, 95% CI 0.244-0.855, p = 0.014), shorter operating time (- 7.172 min, 95%CI - 23.040/- 2.008, p = 0.02), reduced pain at hospital discharge (- 0.356 VAS point, 95%CI - 0.691/- 0.022, p = 0.037). In LVHR, non-transfixing mesh positioning was also a factor for less intraoperative blood loss. In OVHR there were no significant difference in outcomes between groups. In a pragmatic real-world setting, long-term chronic pain appears primarily driven by surgical access and wound-related factors rather than the independent effect of the mesh fixation method. Cyanoacrylate fixation provides significant perioperative advantages, particularly in LVHR.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.