Only-Glue Fixation in Laparoscopic Intraperitoneal Onlay Mesh Repair of Midline Ventral Hernias: Technical Aspects and Short-Term Results of 40 Patients

Mesh fixation remains a key challenge in laparoscopic hernia repair, with no universally accepted technique established to date. This study investigates the clinical application of cyanoacrylate (CA) as the sole fixation method in laparoscopic intraperitoneal onlay mesh (IPOM) repair for midline ventral hernias. A retrospective analysis of patients with midline ventral hernias who underwent IPOM-only glue (IPOM-OG) repair from September 2022 to December 2023 has been carried out. Follow-up was available in 34 (85%) of 40 patients who were operated on during the study period. The majority were primary umbilical hernias, with an average width of 3 cm. Closure of the defect (IPOM +) was performed in 25 (74%) cases, the average hernia-mesh size ratio was 1:16, and the operative time was 64 (40-90) minutes. Two (6%) pseudo-hernias (seroma at the residual sac) were successfully treated with fine-needle percutaneous aspiration. Postoperative visual analog scale (VAS) score of pain in two different measures was low, and no patient complained of chronic pain. Two patients underwent another laparoscopic procedure (cholecystectomy) 14 and 90 days after IPOM-OG, respectively. In both cases, we could confirm that the mesh was adequately positioned without disruptions, wrinkles, bulges, or curled edges. After a median follow-up of 16 (12-26) months, no recurrences or abdominal bulging have been detected. Our proposed technique provides additional data regarding the use of CA as a sole fixation method in IPOM repair of midline ventral hernias. It resulted in a reduction of chronic pain, without jeopardizing the safety of the repair. IPOM-OG may be a suitable option in properly selected patients with small midline hernia defects.