A Comparative Study of N-Butyl Cyanoacrylate with Suture Material for Skin Closure in Open Inguinal Hernia Repair in a Tertiary Care Centre

Abstract

Background: Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide. The choice of skin closure technique plays a crucial role in postoperative recovery, cosmetic outcomes, infection rates, and overall patient satisfaction. Traditionally, sutures have been the preferred method for skin closure, offering strength and flexibility. However, tissue adhesives such as N-Butyl Cyanoacrylate have emerged as a promising alternative due to their faster application time, reduced postoperative pain, and superior cosmesis. The effectiveness and safety of tissue adhesives compared to conventional sutures in inguinal hernia repair remain a subject of clinical interest. This study aims to compare the outcomes of skin closure using N-Butyl Cyanoacrylate versus sutures in open inguinal hernia repair, focusing on wound healing, postoperative pain, cosmesis, and cost-effectiveness.

Objectives: This study aims to evaluate and compare the following parameters between N-Butyl Cyanoacrylate (Group A) and sutures (Group B) for skin closure in open inguinal hernia repair:

• Time required for wound closure.
• Postoperative pain intensity
• Wound infection rates and healing
• Cosmetic outcomes using Vancouver Scar Scale
• Cost-effectiveness of each method

Methods: This was a randomized controlled study conducted at Vinayaka Missions Kirupananda Variyar Medical college and Hospital,Salem,Tamilnadu, India, involving 60 patients diagnosed with inguinal hernia. Patients were randomly assigned to two groups: Group A (n=30), where skin closure was done using N-Butyl Cyanoacrylate, and Group B (n=30), where conventional sutures were used. Data collection included time taken for wound closure, postoperative pain assessment (Visual Analog Scale - VAS), wound infection rates (ASEPSIS score), and cosmetic outcomes (Vancouver Scar Scale). The economic feasibility of both methods was also compared. Statistical analysis was conducted using appropriate parametric and non-parametric tests, with a p-value <0.05 considered statistically significant.

Results: The mean time for wound closure was significantly shorter in the glue group (4.73 ± 1.57 minutes) compared to the suture group (7.10 ± 1.97 minutes, p<0.001). Patients in the N-Butyl Cyanoacrylate group reported significantly lower postoperative pain scores at 6, 12, and 24 hours compared to the suture group (p<0.001). The mean ASEPSIS score for wound infection was lower in the glue group (1.97 ± 0.93) compared to the suture group (3.16 ± 0.62, p<0.001), indicating a lower infection rate in the glue group. Cosmetic assessment using the Vancouver Scar Scale showed better scar outcomes in the glue group (3.23 ± 1.30) compared to the suture group (7.77 ± 0.81, p<0.001). Cost analysis revealed that N-Butyl Cyanoacrylate was more economical due to its faster application time and reduced need for postoperative care.

Conclusion: The findings indicate that N-Butyl Cyanoacrylate is a superior alternative to sutures for skin closure in open inguinal hernia repair, providing shorter wound closure times, reduced postoperative pain, lower infection rates, better cosmetic outcomes, and improved cost-effectiveness. Given these advantages, tissue adhesives should be considered as a preferred option for routine inguinal hernia repairs. Future large-scale studies and long-term follow-ups are recommended to further validate these findings.