Cyanoacrylate Glue Versus Absorbable Tacks in Mesh Fixation for Laparoscopic Extraperitoneal Inguinal Hernia Repair: A Randomized Controlled Trial.

BACKGROUND: Cyanoacrylate glue (Glubran 2) is a synthetic adhesive mesh fixation material. Its utility is being evaluated in laparoscopic total extraperitoneal (TEP) inguinal hernia repair (IHR). A multicentre randomized controlled trial was performed comparing Glubran 2 to standard of care absorbable tacks, particularly assessing chronic postoperative inguinal pain and its effects. MATERIALS AND METHODS: Patients undergoing elective TEP IHR at 2 centers from 2017 to 2019 were randomly assigned to Glubran 2 or absorbable tack mesh fixation, and followed for 6 months. All other aspects of surgery and aftercare remained the same. Surgeons documented operative and fixation time, and the placement of fixation on standardized diagrams. Via a questionnaire, aspects of inguinal pain were evaluated before surgery, and at various time-points postoperatively over 6 months. Postoperative clinical factors were also collected. RESULTS: A total of 106 operative sides were randomized to either glue (51) or tack (55) mesh fixation over a 14-month period. Similar median operative times between tack (83.0 min) and glue fixation (75.0 min) were observed. There were no significant surgical complications or observed hernia recurrences in either group. There was no significant difference in pain scores between the 2 groups at all time-points after analysis through mixed effects modeling. Temporal pain profiles over time were also similar. Totally, 55% of patients in the glue group had returned to work within 2 weeks of surgery. There was no increase in complications or pain scores despite regular lateral fixation of glue in these patients. CONCLUSION: Adding to known data, we observed no significant difference in postoperative pain, demonstrating that cyanoacrylate glue is a viable and safe alternative fixation method to absorbable tacks in laparoscopic TEP IHR. As secondary outcomes, cyanoacrylate glue permits some patients to return to work early, and we observed regular lateral mesh glue fixation without increased pain or complications.

Innate immune, neuroendocrine and behavioral responses to psychosocial stress do not predict subsequent compassion meditation practice time.

Increasing data suggest that meditation impacts stress-related physiological processes relevant to health and disease. For example, our group recently reported that the practice of compassion meditation was associated with reduced innate immune (plasma interleukin [IL]-6) and subjective distress responses to a standardized laboratory psychosocial stressor (Trier Social Stress Test [TSST]). However, because we administered a TSST after, but not prior to, meditation training in our initial study, it remained possible that associations between practice time and TSST outcomes reflected the fact that participants with reduced stress responses prior to training were more able to practice compassion meditation, rather than that meditation practice reduced stress responses. To help resolve this ambiguity, we conducted the current study to evaluate whether innate immune, neuroendocrine and behavioral responses to a TSST conducted prior to compassion meditation training in an independent sample of 32 medically health young adults would predict subsequent amount of meditation practice time during a compassion meditation training protocol identical to the one used in our first study. No associations were found between responses to a TSST administered prior to compassion meditation training and subsequent amount of meditation practice, whether practice time was considered as a continuous variable or whether meditators were divided into high and low practice time groups based on a median split of mean number of practice sessions per week. These findings contrast strikingly with our original study, in which high and low practice time meditators demonstrated marked differences in IL-6 and distress responses to a TSST administered after meditation training. In addition to providing the first published data regarding stress responsivity as a potential predictor of subsequent ability/willingness to practice meditation, the current study strengthens findings from our initial work by supporting the conclusion that in individuals who actively engage in practicing the technique, compassion meditation may represent a viable strategy for reducing potentially deleterious physiological and behavioral responses to psychosocial stress.

Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress.

Meditation practices may impact physiological pathways that are modulated by stress and relevant to disease. While much attention has been paid to meditation practices that emphasize calming the mind, improving focused attention, or developing mindfulness, less is known about meditation practices that foster compassion. Accordingly, the current study examined the effect of compassion meditation on innate immune, neuroendocrine and behavioral responses to psychosocial stress and evaluated the degree to which engagement in meditation practice influenced stress reactivity. Sixty-one healthy adults were randomized to 6 weeks of training in compassion meditation (n=33) or participation in a health discussion control group (n=28) followed by exposure to a standardized laboratory stressor (Trier social stress test [TSST]). Physiologic and behavioral responses to the TSST were determined by repeated assessments of plasma concentrations of interleukin (IL)-6 and cortisol as well as total distress scores on the Profile of Mood States (POMS). No main effect of group assignment on TSST responses was found for IL-6, cortisol or POMS scores. However, within the meditation group, increased meditation practice was correlated with decreased TSST-induced IL-6 (r(p)=-0.46, p=0.008) and POMS distress scores (r(p)=-0.43, p=0.014). Moreover, individuals with meditation practice times above the median exhibited lower TSST-induced IL-6 and POMS distress scores compared to individuals below the median, who did not differ from controls. These data suggest that engagement in compassion meditation may reduce stress-induced immune and behavioral responses, although future studies are required to determine whether individuals who engage in compassion meditation techniques are more likely to exhibit reduced stress reactivity.