Why this question kept coming up
Laparoscopic (keyhole) hernia repair is now the gold standard. During surgery, doctors place a small mesh patch over the weak spot to reinforce it. Most surgeons then attach that mesh using tacks or staples — tiny fasteners that grip the tissue.
The problem? Those tacks and staples can press on nearby nerves. And that pressure is thought to be one reason some patients still feel groin pain months after surgery.
Non-penetrating fixation — using surgical glue or a self-adhesive mesh — doesn't pierce the tissue at all. In theory, no piercing means less nerve irritation and less long-term pain.
The old approach — and why it's being questioned
For years, surgeons assumed that if you didn't firmly anchor the mesh, it might shift. And a shifted mesh could mean the hernia comes back.
But here's the twist: glue holds things together too. It just works differently — like two puzzle pieces held by adhesive instead of screws. The patch bonds to the tissue without any sharp points pressing into nerves.
Researchers wanted to know: does glue work as well as staples at keeping hernia repairs intact? And does it actually reduce pain?
How these two methods stack up
Think of it like two ways to hang a picture. Staples punch into the wall and grip hard. Glue bonds the surfaces without any holes. Both can hold the picture — but one is a lot less invasive to the wall.
In hernia repair, "the wall" is living tissue threaded with nerves. Anything that pierces it has the potential to cause lasting sensitivity. Glue sidesteps that problem entirely.
What the review covered
Researchers pooled data from 35 randomized controlled trials — the gold standard of medical research — involving 4,329 adults, mostly men, who had laparoscopic groin hernia surgery. They compared penetrating methods (tacks, staples, sutures) against non-penetrating methods (fibrin glue, cyanoacrylate glue, self-adhesive mesh). The review was published in the Cochrane Database of Systematic Reviews in April 2026.
For the two most important outcomes — chronic pain (pain lasting six months or more after surgery) and hernia coming back — neither method came out clearly on top. The risk of long-term pain was similar between groups, and so was the rate of recurrence (the hernia returning).
When it came to pain scores on a scale — rather than just yes or no — glue showed a small advantage. Patients in the glue group reported slightly lower pain levels both right after surgery and months later. Glue was also linked to fewer bruising events (hematomas) and a slightly shorter recovery time. These results are promising, but all were rated as very low-certainty evidence.
That means the findings could change significantly as better studies are done.
The honest picture on evidence quality
This is where things get interesting — and important. The researchers rated the certainty of evidence as "very low" for almost every outcome. That's not because the results were bad. It's because many of the 35 trials had gaps in their methods, incomplete data reporting, or were too small to draw firm conclusions.
In medical research, "very low certainty" is a flag that says: this is the best data we have right now, but it may not reflect the full truth.
If you're scheduled for laparoscopic hernia repair, this review is worth knowing about — but it doesn't give you a clear directive yet. Both glue and staples remain accepted options. There is no strong evidence that one is dramatically better than the other for preventing hernia recurrence.
What's worth asking your surgeon: what fixation method they typically use, and whether glue might be appropriate for you — especially if you're worried about long-term nerve pain.
Limitations worth knowing
Most participants in these trials were men with primary, uncomplicated hernias. Women and people with more complex cases were underrepresented. The studies were also conducted across many different countries using slightly different techniques, which makes direct comparisons tricky.
More well-designed trials with clearer methods and longer follow-up are needed before surgeons can confidently recommend one method over the other. The good news is that both approaches appear to be safe. As more high-quality data accumulates, future guidelines may be able to give patients and surgeons a clearer, more personalized answer.
