Abstract
BACKGROUND: In hernia repair, mesh fixation methods impact postoperative pain and recovery. While penetrating fixations such as tacks or sutures may cause chronic pain, non-penetrating alternatives such as n-butyl-2-cyanoacrylate (NB2C) glue remain under investigation. METHODS: A meta-analysis of randomized controlled trials (RCTs) was conducted to compare NB2C with sutures or tacks in groin hernia repair. Databases searched included PubMed, Web of Science, Embase, Cochrane Library, and Scopus (up to April 28, 2025). Primary outcomes were postoperative pain (VAS) and operative time; secondary outcomes included complications and recurrence. RESULTS: Seven RCTs involving 1111 patients were included. Compared with sutures, NB2C was associated with reduced postoperative pain (MD - 0.72; 95% CI - 1.42 to - 0.02; p = 0.04) and shorter operative time (MD - 3.86 min; 95% CI - 5.27 to - 2.44; p < 0.01). No significant differences were observed between NB2C and tacks regarding pain or complications, nor between NB2C and sutures regarding complications and recurrence. CONCLUSION: NB2C offers reduced pain and operative time compared to sutures but shows no clear advantage over tacks.