***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s . Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5 % of patients . The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair . Methods Sixty-six ( 66 ) patients with unilateral uncomplicated inguinal hernia were r and omized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair . The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein , white blood cell count at 48 h , and ESR at 3 months postoperatively . Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period . Results The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values ( p < 0.05 ) , however , did not differ significantly between the two study groups at 48 h ( p > 0.05 ) . The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only ( p < 0.05 ) , however , did not differ significantly between the two study groups ( p > 0.05 ) . There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group ( p > 0.05 ) . Conclusion Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible The totally extraperitoneal ( TEP ) approach for surgical repair of inguinal hernias has emerged as a popular technique . We conducted a prospect i ve r and omised trial to compare patient comfort scores using different mesh types and fixation using this technique . Over a 14 month period , 146 patients underwent 232 TEP inguinal hernia repairs . We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation . A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks ( Control group ) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks ( Group 2 ) , a partially-absorbable 15 × 10 cm mesh with absorbable tacks ( Group 3 ) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant ( Group 4 ) . Outcomes were compared at 1 , 2 , 4 and 12 weeks using the Carolina Comfort Scale ( CCS ) scores . At 1 , 2 , 4 and 12 weeks , the median global CCS scores were low for all treatment groups . Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks ( Group 3 ) at weeks 2 and 4 . However , these were no longer significant at week 12 . In this study , the TEP inguinal hernia repair with minimal fixation results in low CCS scores . There were no statistical differences in CCS scores when comparing types of mesh , configuration of the mesh or fixation methods Background Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia . Hypoesthesia in particular is generally not assessed objective ly . We objective ly investigated hypoesthesia and chronic pain  after transabdominal preperitoneal inguinal hernia repair ( TAPP ) with titanium spiral tacks ( STs ) compared with tissue adhesive ( TA ) for mesh fixation . Methods Mesh fixation in 80 TAPP procedures was r and omized to fixation with ST ( n = 40 ) or TA ( n = 40 ) . The outcome parameters included hypoesthesia assessed with von Frey monofilaments , early postoperative and chronic pain with the visual analog scale ( VAS ) , morbidity ( surgical-site infection , hematoma/seroma , relapse of hernia , trocar hernia ) , and recovery time to normal activity . Results Median ( range ) follow-up was 38 ( 13–56 ) months . Demographic and baseline parameters were similar in the two groups . Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group ( 6 weeks : 32 vs. 6 % ; 6 months : 38 vs. 14 % ; 12 months : 34 vs. 13 % ; 13–56 months : 32 vs. 4 % ) . Mean hypoesthesia scores over all time points were significantly higher in the ST group . The percentages of regions with hypoesthesia ( abdominal , inguinal , or genitofemoral ) following all procedures were higher in the ST group after 6 weeks ( 14 vs. 2 % ) , 6 months ( 15 vs. 5 % ) , and 13–56 months ( 22 vs. 4 % ) . The intensity of pain decreased significantly in both groups over time . Conclusions Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling Background Mesh reinforcement has become the st and ard of care in the open and laparoscopic repair of inguinal hernia .  Chronic pain after inguinal hernia repair is often due to nerve injury by penetrating mesh fixation devices such as staples ( ST ) , tacks , or sutures . In several studies on hernioplasty , atraumatic mesh fixation with fibrin sealant ( FS ) proved to be efficient in terms of fixation strength and elasticity . Unfortunately , most of these studies did not provide a st and ardized follow-up and assessment of the development of chronic pain ( CP ) and the quality of life ( QoL ) . Therefore , a r and omized controlled trial comparing CP and QoL after FS fixation of mesh with ST  in transabdominal preperitoneal hernioplasty ( TAPP ) was performed at our department . The primary end point of our study was to assess the patient outcome by using a visual analog scale ( VAS ) and the short form 36 ( SF-36 ) . The evaluation of recurrence rates was the secondary aim . Methods According to the r and omization , a macroporous mesh ( TiMESH ® ) was fixed in group A ( 44 patients with 54 inguinal hernias ) with FS ( TISSEEL ) or in group B ( 45 patients with 56 inguinal hernias )  with ST ( EMS ® Stapler ) . The observation period was 1 year with regular clinical check ups and assessment of VAS and SF-36 . Results Patient characteristics expressed by BMI , ASA scores , and Schumpelick hernia classification were similar in both treatment groups . In each group there was one recurrence within 8 ( FS ) and 9 months ( ST ) postsurgery . The mean preoperative pain values scored by VAS were 1.7 ( range = 0–7.5 ) in the FS group and 2.2 ( range = 0–6 ) in the ST group . Postoperative mean VAS scores measured at 1 year postsurgery were 0.4 ( range = 0–3 ) in the FS group and 0.9 ( range = 0–7.5 ) in the ST group . One year postsurgery there was no significant difference between the two groups with respect to the parameter pain in the SF-36 and VAS . Conclusion Fibrin sealant fixation leads to a low rate of hernia recurrence and avoids tissue trauma . ST provide similar results in the h and of the expert but bear inherent risks of complications due to tissue perforation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective : To compare the clinical outcome of simultaneous bilateral endoscopic totally extraperitoneal inguinal hernioplasty ( TEP )  using fibrin sealant ( FS ) and mechanical stapling for prosthetic mesh fixation . Summary Background Data : Similar efficacy of FS and mechanical stapling for mesh fixation has been demonstrated in a swine model , but no clinical trial has been conducted to compare the outcomes of TEP using these 2 fixation devices . FS adheres the prosthetic mesh without causing injury to the underlying structures . Whether the application of FS improves early postoperative outcomes , namely , reduction of postoperative pain and seroma formation , has not been examined . Patients and Methods : Between July 2002 and February 2004 , a total of 93 patients with 186 inguinal hernias who underwent bilateral TEP were r and omized to have mesh fixation by either FS ( n = 46 ) or mechanical stapling ( n = 47 ) . The primary endpoints were severity of pain , analgesic requirement , and incidence of seroma . Secondary endpoints were length of hospital stay , number of days required to resume normal outdoor activities and work , recurrence rate , and incidence of chronic pain . Results : The 2 groups were comparable in age , sex , and types of hernia . TEP were successfully performed in all patients . The FS group consumed significantly less analgesics compared with that of the staple group ( P = 0.034 ) . There was no significant difference in the postoperative pain score at rest and on coughing from the day of operation to postoperative day 6 between the groups . The incidence of seroma was significantly higher in the FS group ( 17.4 % ) than the staple group ( 5.3 % ) ( P = 0.009 ) . Length of hospital stay and time taken to resume normal activities and work were comparable between the 2 groups . With a median follow-up of 1.2 years , no recurrent hernia has been detected in either group , but the incidence of chronic pain in the staple group ( 20.0 % ) was higher than that of the FS group ( 13.2 % ) ( P = 0.418 ) . Conclusions : This r and omized prospect i ve clinical trial demonstrated a significant reduction of analgesic consumption by using FS for mesh fixation during bilateral TEP , but it was associated with an increased incidence of postoperative seroma Background Preliminary studies have indicated clinical advantages of mesh fixation using fibrin glue in transabdominal preperitoneal groin hernia repair ( TAPP ) compared with tack fixation . The aim of this r and omized double-blinded , controlled , clinical trial is to compare fibrin glue with tacks fixation of mesh during TAPP . Methods One hundred and twelve men with unilateral inguinal hernia were enrolled . Primary outcome was pain during coughing on postoperative day 1 . Secondary outcomes were postoperative scores of pain at rest , discomfort , and fatigue ( day 1 and cumulated day 0–3 ) , incidence of moderate/severe nausea and /or vomiting , foreign-body sensation , and recurrence after 6 months . Outcome measures were assessed by visual analogue scale ( VAS , 0–100 mm ) , verbal rating scale ( no , light , moderate or severe ) and numerical rating scales ( NRS , 1–10 ) . Results One hundred patients were available for analysis . The fibrin group ( n = 50 ) had significantly less pain during coughing on day 1 compared with the tacks group ( n = 50 ) [ median 23 ( range 0–80 ) vs 35 ( 2–100 ) mm ] ( p = 0.020 ) . Moreover , day 1 scores and all cumulated scores of pain during rest , discomfort , and fatigue were significantly lower in the fibrin group compared with the tacks group ( all p-values ≤ 0.02 ) . There was no significant difference in the incidence of nausea and /or vomiting ( p > 0.05 ) or recurrence  ( fibrin glue n = 2 , tacks n = 0 , p = 0.241 ) . Incidence of foreign-body sensation was significantly lower in the fibrin group at 1 month ( p = 0.006 ) . Conclusions Fibrin glue compared with tacks fixation improved the early postoperative outcome after TAPP . The trial was registered at clinical trials.gov NCT01000116 Background . The morbidity linked to the use of sutures in inguinal hernioplasty is well known . Tissue adhesives may be an alternative , so as to be able to improve levels of postoperative comfort , but clinical experience using them is limited . The aim of this study is to evaluate the efficiency of cyanoacrylate as a substitute for sutures in the treatment of inguinal hernias . Patients . R and omized clinical trial in abdominal wall unit . A total of 208 patients were operated upon for inguinal hernias of which 102 were unilateral hernias via open surgery using the Lichtenstein technique , r and omized to receive prolene sutures ( n = 52 ) or n-hexyl-α-cyanoacrylate glue ( n = 50 ) and 106 were patients with bilateral inguinal hernias operated upon via totally extraperitoneal laparoscopy and r and omized to receive either tackers ( n = 54 ) or glue ( n = 52 ) . Main Outcome Measures . The primary endpoints were pain and recurrence . Secondary endpoints were operating time , postoperative morbidity , pain , and analgesic consumption . Results . No morbidity associated with the use of the glue existed . The use of glue significantly reduced the mean of surgical time ( 12 minutes in open surgery , 13 minutes in laparoscopic surgery ) , pain , and analgesics consumption , both via the open and laparos 
    Output:
    
Glue fixation in laparoscopic  inguinal hernia repair reduces the incidence of urinary retention and may reduce the rate of hematoma or seroma formation .