Hernia Surgery pp 287-295 | Cite as

Evidence-Based Optimal Fixation During Laparoscopic Hernia Repair: Sutures, Tacks, and Glues

  • H. Reza Zahiri
  • Igor BelyanskyEmail author



Mesh fixation during ventral and inguinal hernia repair is a critical step which should aim to secure the mesh in place to prevent recurrence of hernia while promoting rapid ingrowth and reducing associated complications, pain, formation of adhesions, and mesh shrinkage. The purpose of this chapter is to provide an up-to-date and evidence-supported review of fixation products and techniques in laparoscopic ventral and inguinal hernia repair.


The authors conducted a literature search using PubMed Database, from year 1990 to current, using the following terms: mesh; fixation; tacks; sutures, adhesives, inguinal hernia, ventral hernia, laparoscopic repairs. All relevant retrospective and prospective studies were reviewed and included for writing of this chapter.

Additionally, authors describe their own experience and practice with regard to mesh fixation in the laparoscopic repair of inguinal and ventral hernias.


Seventeen various devices used for mesh fixation are described, divided into four categories: Nonabsorbable tacks, absorbable tacks, sutures, and glues.

While there is some indication that sutures add additional stability to fixation of mesh, they may also be associated with more acute and chronic pain. Tacks and staples may reduce pain compared to sutures, but may not prevent mesh shrinkage and migration and are more invasive than glue fixation. Glue fixation which has not been definitively shown to be inferior to other fixation modalities, although data indicates its trend towards higher recurrence rates.


Overall, the current literature does not consistently support any particular fixation technique as superior. Selecting the right mesh fixation device and technique must take into consideration the type of hernia, size of defect, type of mesh, and patient anatomy.


Ventral hernia Inguinal hernia Laparoscopic repair Mesh Fixation device Sutures Tacks Adhesives Absorbable Nonabsorbable 



We would like to thank Mr. Ivan George and Mr. Paxton Paganelli for all their help and efforts in preparing our graphics and figure illustrations.


  1. 1.
    Harslof SS, Wara P, Friis-Andersen H. Fixation devices in laparoscopic ventral hernia repair: a review. Surg Technol Int. 2014;24:203–13.PubMedGoogle Scholar
  2. 2.
    Morales-Conde S, Cadet H, Cano A, et al. Laparoscopic ventral hernia repair without sutures-double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg. 2005;90:S56–62.PubMedGoogle Scholar
  3. 3.
    Heniford BT, Park A, Ramshaw BJ, et al. Laparoscopic repair of ventral hernias: nine Years’ experience with 850 consecutive hernias. Ann Surg. 2003;238:391–400.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Garcea G, Ngu W, Neal CP, et al. Results from a consecutive series of laparoscopic incisional and ventral hernia repair. Surg Laparosc Endosc Percutan Tech. 2012;21:173–80.Google Scholar
  5. 5.
    Itani KM, Hur K, Kim LT, et al. Veterans affairs ventral incisional hernia investigators. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg. 2010;145:322–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Lahon M, Simoens C, Thill V, et al. A retrospective study of 74 laparoscopic repair of incisional hernias. Acta Chir Belg. 2009;109:595–601.CrossRefPubMedGoogle Scholar
  7. 7.
    Carbajo MA, del Olmo JCM, Blanco JI, et al. Laparoscopic treatment versus open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc. 1999;13:250–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Barbaros U, Asoglu O, Seven R, et al. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia. 2007;11:51–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Bencini L, Sanchez LJ, Boffi B, et al. Incisional hernia repair: retrospective comparison of laparoscopic and open techniques. Surg Endosc. 2003;17:1546–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Stickel M, Rentsch M, Clevert DA, et al. Laparoscopic mesh repair of incisional hernia: an alternative to the conventional open repair? Hernia. 2007;11:217–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Gananadha S, Samra JS, Smith GS, et al. Laparoscopic ePTFE mesh repair of incisional and ventral hernias. ANZ J Surg. 2008;78:907–13.CrossRefPubMedGoogle Scholar
  12. 12.
    Chelala E, Thoma M, Tatete B, et al. The suturing concept for laparoscopic mesh fixation in ventral and incisional hernia repair: mid-term analysis of 400 cases. Surg Endosc. 2007;21:391–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Palanivelu C, Jani KV, Senthilnathan P, et al. Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia. 2007;11:223–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Carbajo MA, del Olmo JCM, Blanco JI, et al. Laparoscopic approach to incisional hernia. Surg Endosc. 2003;17:118–22.CrossRefPubMedGoogle Scholar
  15. 15.
    Reitter DR, Paulsen JK, Debord JR, et al. Five-year experience with the “four-before” laparoscopic ventral hernia repair. Am Surg. 2000;66:465–9.PubMedGoogle Scholar
  16. 16.
    Parker 3rd HH, Nottingham JM, Bynoe RP, et al. Laparoscopic repair of large incisional hernias. Am Surg. 2002;68:530–4.PubMedGoogle Scholar
  17. 17.
    Cobb WS, Kercher KW, Matthews BD, et al. Laparoscopic ventral hernia repair: a single center experience. Hernia. 2006;10:236–42.CrossRefPubMedGoogle Scholar
  18. 18.
    Saber AA, Elgamal MH, Rao AJ, et al. A simplified laparoscopic ventral hernia repair: the scroll technique. Surg Endosc. 2008;22:2527–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Olmi S, Brba L, Magnone S, Bertolini A, et al. Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: indications, complications and results. Hernia. 2006;10:243–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Baccari P, Nifosi J, Ghirardelli L, et al. Laparoscopic incisional and ventral hernia repair without sutures: a single-center experience with 200 cases. J Laparoendosc Adv Surg Tech A. 2009;19:175–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Bencini L, Sanchez LJ, Bernini M, et al. Predictors of recurrence after laparoscopic ventral hernia repair. Surg Laparosc Endosc Percutan Tech. 2009;19:128–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Moreno-Egea A, Bustos JA, Girela E, et al. Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh. Surg Endosc. 2010;24:359–65.CrossRefPubMedGoogle Scholar
  23. 23.
    Theodoropoulou K, Lethaby D, Hill J, et al. Laparoscopic hernia repair: a two-port technique. JSLS. 2010;14:103–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Alkhoury FHS, Ippolito R. Cost and clinical outcomes of laparoscopic ventral hernia repair using intraperitoneal nonheavyweight polyprolene mesh. Surg Laparosc Endosc Percutan Tech. 2011;21:82–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Muysoms F, Vander-Mijnsbrugge G, Pletinckx P, et al. Randomized clinical trial of mesh fixation with “double crown” versus “sutures and tackers” in laparoscopic ventral hernia repair. Hernia. 2013;17:603–12.CrossRefPubMedGoogle Scholar
  26. 26.
    DeLoach LJ, Higgins MS, Caplan AB, et al. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998;86:102–6.PubMedGoogle Scholar
  27. 27.
    Gallagher EJ, Bijur PE, Latimer C, et al. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002;20:287–90.CrossRefPubMedGoogle Scholar
  28. 28.
    Eriksen JR, Bisgaard T, Assaadzadeh S, et al. Fibrin sealant for mesh fixation in laparoscopic umbilical hernia repair: 1-year results of a randomized controlled double-blinded study. Hernia. 2013;17(4):511–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Bansal VK, Misra MC, Babu D, et al. Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study. Surg Endosc. 2012;26(12):3476–85.CrossRefPubMedGoogle Scholar
  30. 30.
    Bansal VK, Misra MC, Kumar S, et al. A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc. 2011;25(5):1431–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Beldi G, Wagner M, Bruegger LE, et al. Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc. 2011;25:749–55.CrossRefPubMedGoogle Scholar
  32. 32.
    Wassenaar E, Schoenmaeckers E, Raymakers J, et al. Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc. 2010;24:1296–302.CrossRefPubMedGoogle Scholar
  33. 33.
    Reynvoet E, Deschepper E, Rogiers X, et al. Laparoscopic ventral hernia repair: is there Ann optimal mesh fixation technique? a systematic review. Langenbecks Arch Surg. 2014;399:55–63.CrossRefPubMedGoogle Scholar
  34. 34.
    Cavallaro G, Campanile FC, Rizzello M, et al. Lightweight polypropylene mesh fixation in laparoscopic incisional hernia repair. Min Inv Ther. 2013;22:283–7.CrossRefGoogle Scholar
  35. 35.
    Brill JB, Tuner PL. Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg. 2011;4:458–65.Google Scholar
  36. 36.
    Olmi S, Cesana G, Sagutti L, et al. Laparoscopic incisional hernia repair with fibrin glue in select patients. JSLS. 2010;14:240–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Hollinsky C, Kolbe T, Walter I, et al. Tensile strength and adhesion formation of mesh fixation systems used in laparoscopic incisional hernia repair. Surg Endosc. 2010;24:1318–24.CrossRefPubMedGoogle Scholar
  38. 38.
    LeBlanc KA, Stout RW, Kearney MT, et al. Comparison of adhesions formation associated with pro-tack (US surgical) versus a new mesh fixation device, salute (ONUX medical). Surg Endosc. 2003;17:1409–17.CrossRefPubMedGoogle Scholar
  39. 39.
    Melman L, Jenkins ED, Deeken CR, et al. Evaluation of acute fixation strength for mechanical tacking devices and fibrin sealant versus polypropylene suture for laparoscopic ventral hernia repair. Surg Innov. 2010;17:285–90.CrossRefPubMedGoogle Scholar
  40. 40.
    Dilege E, Deveci U, Erbil Y, et al. N-butyl cyanoacrylate versus conventional suturing for fixation of meshes in an incisional hernia model. J Invest Surg. 2010;23:262–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Hollinsky C, Kolbe T, Walter I, et al. Comaprison of a new self-gripping mesh with other fixation methods for laparoscopic hernia repair in a rat model. J Am Coll. 2009;208:1107–14.CrossRefGoogle Scholar
  42. 42.
    Clarke T, Katkhouda N, Mason RJ, et al. Fibrin glue for Intraperitoneal laparoscopic mesh fixation: a comparative study in a swine model. Surg Endosc. 2011;25:737–48.CrossRefPubMedGoogle Scholar
  43. 43.
    van’t Riet M, de vos van Steenwijk PJ, Kleinrensink GJ, et al. Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair. Surg Endosc. 2002;16:1713–6.CrossRefGoogle Scholar
  44. 44.
    Petter-Puchner AH, Fortelny R, Mitter-mayr R, et al. Fibrin sealing versus stapling of hernia meshes in an onlay model in the rat. Hernia. 2005;9:322–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Jenkins ED, Melman L, Desai S, et al. Evaluation of intraperitoneal placement of absorbable and nonabsorbable barrier coated mesh secured with fibrin sealant in a New Zealand white rabbit model. Surg Endosc. 2011;25:604–12.CrossRefPubMedGoogle Scholar
  46. 46.
    Gruber-Blum S, Petter-Puchner AH, Mika K, et al. A comparison of a bovine albumin/glutaraldehyde glue versus fibrin sealant for hernia mesh fixation in experimental onlay and IPOM repair in rats. Surg Endosc. 2010;24:3086–94.CrossRefPubMedGoogle Scholar
  47. 47.
    Fortelny RH, Petter-Puchner AH, Walder N, et al. Cyanoacrylate tissue sealant impairs tissue integration of macroporous mesh in experimental hernia repair. Surg Endosc. 2007;21:1781–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Ladurner R, Drosse I, Burklein D, et al. Cyanoacrylate glue for intra-abdominal mesh fixation of polypropylene-polyvinylidene fluoride meshes in a rabbit model. J Surg Res. 2011;167:e157–62.CrossRefPubMedGoogle Scholar
  49. 49.
    Losi P, Burchielli S, Spiller D, et al. Cyanoacrylate surgical glue as an alternative to suture threads for mesh fixation in hernia repair. J Surg Res. 2010;163:e53–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Reynvoet E, Berrevoet F, De Somer F, et al. Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair. Surg Endosc. 2012;26(9):1–8.CrossRefGoogle Scholar
  51. 51.
    Eriksen JR, Bech JI, Linnemann D, et al. Laparoscopic intraperitoneal mesh fixation with fibrin sealant (Tisseel) vs. titanium tacks: a randomised controlled experimental study in pigs. Hernia. 2008;12:483–91.CrossRefPubMedGoogle Scholar
  52. 52.
    Zinther NB, Wara P, Friis-Andersen H. Intraperitoneal onlay mesh: an experimental study of adhesion formations in a sheep model. Hernia. 2010;14:283–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Byrd JF, Agee N, Swan RZ, et al. Evaluation of absorbable and permanent mesh fixation devices: adhesion formation and mechanical strength. Hernia. 2011;15:553–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Petter-Puchner AH, Walder N, Redl H, et al. Fibrin sealant (Tissucol) enhances tissue integration of condensed polytetrafluoroethylene meshes and reduces early adhesion formation in experimental intraabdominal peritoneal onlay mesh repair. J Surg Res. 2008;150:190–5.CrossRefPubMedGoogle Scholar
  55. 55.
    Kaul A, Hutfless S, Le H, et al. Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc. 2012;26:1269–78.CrossRefPubMedGoogle Scholar
  56. 56.
    Hindmarsh AC, Cheong E, Lewis MPN, et al. Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs. Br J Surg. 2003;90:1152–4.CrossRefPubMedGoogle Scholar
  57. 57.
    Melissa CS, Yuen Bun TA, Wing CK, et al. Randomized double-blinded prospective trial of fibrin sealant spray versus mechanical stapling in laparoscopic total extraperitoneal hernioplasty. Ann Surg. 2014;259(3):432–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Fortelny RH, Petter-Puchner AH, May C, et al. The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of a randomized controlled study. Surg Endosc. 2012;26(1):249–54.CrossRefPubMedGoogle Scholar
  59. 59.
    Lovisetto F, Zonta S, Rota E, et al. Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective randomized study. Ann Surg. 2007;245(2):222–31.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Lau H. Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty. Ann Surg. 2005;242(5):670–4.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Belyansky I, Tsirline VB, Klima DA, et al. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg. 2011;254(5):709–15.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA

Personalised recommendations