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Ielpo. Mini-invasive Surg 2021;5:10 I http://dx.doi.org/10.20517/2574-1225.2020.01 Page 5 of 6

An alternative to cyanoacrylate is the biological human fibrine, which has the double function of both
glue and hemostatic. Different from cyanoacrylate, there is more evidence in the literature that fibrine
glue may prevent peritoneal adhesions, and it may represent the optimal and safest method to close the
[11]
peritoneum . We believe that the key advantage of the modified technique, where we completely replace
the running suture with fibrine glue to approximate the peritoneum, is particularly useful for those cases
where the peritoneum is at a higher risk of tear or rupture during closure.

According to our experience, in our previous published study, we were able to show a decreased operative
[3]
time of the procedure while also maintaining acceptable postoperative outcomes and quality of life . To
date, this is the unique study showing long-term results using fibrine glue to both fix the mesh and close
the peritoneum.

Furthermore, according to our experience, we found the peritoneal closure with fibrine glue a simple to
learn and master maneuver that does not require specific skills.

CONCLUSION
Tips and tricks
Avoid use of stapler to fix the mesh and close the peritoneum.

The knowledge of some alternatives of the technique are paramount in challenging inguinal hernia repairs,
for example: Peritoneal closure can be performed using glue when its closure is challenging. When a
specific mesh is not available, it is paramount to know how to prepare it.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

REFERENCES

1. Ielpo B, Nuñez-Alfonsel J, Duran H, et al. Cost-effectiveness of randomized study of laparoscopic versus open bilateral inguinal hernia
repair. Ann Surg 2018;268:725-30.