J Minim Invasive Surg 2018; 21(3): 106-111  
The Impact of Double Fixation with Titanium Tack and N-Butyl Cyanoacrylate Glue (NBCG) Mesh Fixation versus NBCG Fixation Only in Totally Extra-Peritoneal Hernioplasty with 3-Dimensional Configured Polyester Mesh: A Comparative Study
Kejin Chen, M.S.1, Jianwen Liu, M.S.1, Xuefei Yang, M.D.1, Joe King Man Fan, MBBS MS (HKU) FRCSEd1,2
Department of Surgery, 1The University of Hong Kong-Shenzhen Hospital, Shenzhen, 2Li Ka Shing Faculty of Medicine, The University of Hong Kong, HKSAR, China
Correspondence to: Joe King Man Fan
Department of Surgery, The University of Hong Kong, Pokfulam Road, Hong Kong
Tel: +852-22554763 Fax: +852-28728425 E-mail: drjoefan@hku.hk
ORCID:http://orcid.org/0000-0001-6604-2295
Received: December 29, 2017; Revised: July 11, 2018; Accepted: July 30, 2018; Published online: September 15, 2018.
© Journal of Minimally Invasive Surgery. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Our aim is to compare 3-dimensional mesh fixation using titanium tacks combine with n-butyl cyanoacrylate glue (NBCG) (COMBINE group) versus NBCG only (NBCG group) in totally extraperitoneal inguinal hernioplasty (TEP).
Methods: This is a retrospectively study of patients diagnosed with unilateral inguinal hernia and underwent TEP with 3-dimensional configured polyester mesh fixation using titanium tacks combine NBCG or NBCG only at the University of Hong Kong-Shenzhen Hospital with data prospectively collected. Operative details and outcomes were compared including: operating time, size of defect, total hospital cost, post-operative pain scores and recurrence.
Results: From 08.2013 to 03.2016 a total of 219 patients were included. There was no significant difference between COMBINE group and NBCG group in mean age (52.5 years versus 48.2 years), mean size of defects (2.4 cm versus 2.6 cm), and operating time (121 mins versus 111 mins). There were significant differences between COMBINE group and NBCG group in total hospital cost (3035 USD versus 2022 USD), post-operative pain score on day 2 to day 4 (VAS: 1.4 versus 1.0, 1.0 versus 0.4, 0.5 versus 0.2). There was one recurrence in COMBINE group (p=0.276) with overall recurrence of 0.46%.
Conclusion: Patients with inguinal hernia underwent TEP with 3-dimensional configured polyester mesh with NBCG fixation only having comparative surgical outcome to COMBINE group. A recurrence of 0.46% can be achieved with this combination. Tacks fixation may cause more post-operative pain and increase hospital cost. Use of N-butyl cyanoacrylate glue in TEP is safe and effective in our clinical series.
Keywords: Inguinal hernia, Mesh fixation, Titanium tacks, N-Butyl Cyanoacrylate Glue, Laparoscopic


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