Cyanoacrylate glue for hernia mesh fixation

The technology described in this briefing is cyanoacrylate glue. It is used for mesh fixation in hernia repair procedures.

The innovative aspects are that using glue limits trauma to surrounding tissues. Innovative applicators have also been developed for precise, accurate placement of the adhesive.

The intended place in therapy would be as an alternative to mechanical mesh fixation methods such as sutures and tacks in people having surgical hernia repair.

The main points from the evidence summarised in this briefing are from 3 systematic reviews and 2 randomised controlled trials, including a total of 1,374 people who were randomised to cyanoacrylate glue groups. These studies show that cyanoacrylate glue is as effective as alternative methods of mesh fixation, such as mechanical methods or fibrin glue. The evidence does not show any advantage of cyanoacrylate glue for the incidence of postoperative chronic pain.

Key uncertainties around the evidence or technology are the comparative costs of alternatives in the NHS, because there is no clinical consensus on standard mesh fixation methods.

Experts advised that, although the main potential advantage of cyanoacrylate glue is that it could help avoid traumatic complications such as chronic pain, studies with follow up beyond 1 year after the procedure are needed to evaluate this outcome.

The cost of cyanoacrylate glue (including applicators) for hernia mesh fixation range from £97 to £230 per unit (excluding VAT) for laparoscopic procedures, and from £65 to £230 per unit (excluding VAT) for open procedures. There is no consensus about standard mesh fixation methods in the NHS. Clinical expert advised an estimated cost of tacking devices was appropriately £206 (ranging from £160 to £241). Companies and experts estimated that the cost of a box of 12 sutures ranged from £23 to £92.