inguinal hernia is the protrusion of abdominal organs into the inguinal canal through the natural or acquired defect of the abdominal wall . operation of inguinal hernia represent the most frequent surgical intervention in the domain of general surgery with about twenty million procedures performed a year worldwide . frequency of inguinal hernia in men is 25% , and in women 2% . in men , indirect inguinal hernias risk of inguinal hernia increases with age and annual incidence in persons older than 75 years is about 50% . on average about two thirds of inguinal hernias are indirect and one third is direct ( 1 ) . application of prosthetic mesh in inguinal hernia repair results in reduced incidence of relapse , and fibrin glue used as mesh fixative , has contributed to comfortable postoperative period with mild controlled pain and rapid return to daily activities . the method is simple and it can be performed by all surgeons , even by those who have no special interest in hernia surgery . the aim of this study was to compare two methods of fixation of polypropylene mesh for inguinal hernia repair according to lichtenstein , using fibrin glue fixation and suture fixation . prospective and retrospective analysis of 60 patients , who underwent inguinal hernia surgery , were performed at the department of surgery , university clinical center in tuzla . the experimental group consisted of 30 patients who underwent surgery using the modified method by lichtenstein the control group consisted of 30 patients who underwent surgery using a conventional method by lichtenstein  suture polypropylene mesh fixation . both groups were proportionally represented by patients with unilateral , direct ( m1 , m2 ) and indirect ( l1 , l2 ) , inguinal hernia , age 18 to 80 years with physical status asa 1 and asa . from the study were excluded : persons with recurrent , bilateral and hernia type l3 and m3 , persons with body mass index above 35kg / m , those with prolonged use of analgetics , steroids , and anticoagulant drugs , persons addicted to alcohol or drugs , persons suffering from cirrhosis of the liver , with immunodeficiency syndrome , and severe damage to physical or mental health that could affect the investigation . all patients were analyzed according to the following information : age , gender , body mass index ( bmi ) , type , location and size of the hernia , preoperative level of pain ( presurgical pain level ) , surgical techniques , intrasurgical complications , duration of surgery , postsurgical pain level , postsurgical complication ( ecchymosis , hematoma , seroma , wound infection , pain ) , reintervention , postsurgical hospital stay , postsurgical quality of life and postsurgical functional activities . all patients were classified according to the standard anesthetic protocol asa ( american society of anesthesiologists ) and had surgery under general anesthesia . polypropylene mesh ( prolene , ethicon germany , weight 100g / m2 , 164x96 micron pore size , dimensions 15x8 cm ) , is placed on the back wall of the inguinal canal , and the fixation of the mesh is done with individual slowly resorbable suture ( poliglactin 910vicryl 2.0 ) and fibrin glue ( tissucol kit , baxter , usa ) , ( figure 1 ) . polypropylene mesh fixation with fibrin glue ( tissucol ) overall postoperative complications and the patient s ability to return to regular activities were followed for 3 months . postoperative patients examination was made after 7 days , 1 month , and 3 months . pain level was evaluated by visual analogue scale ( vas ) , graded from 0 - 10 , before surgery , first day after surgery , seventh day after surgery , 1 month and 3 months after surgery . in statistical data analysis methods of descriptive and inferential statistics data are expressed as the median value and range or the mean  standard deviation appropriate . a p - value less than 0.05 was considered as significant in all of the tests . the study included 56 male ( 93.3% ) and 4 female ( 6.7% ) patients , evenly distributed in groups . group a had an average age of 52.3 years and group b of 50.3 years . preoperative characteristics of patients in 35 ( 58.3% ) patients right - sided hernias were found ( group a-17 , group b-18 ) , and in 25 ( 41.7% ) patients left - sided hernias were found ( group a-13 , group b-12 ) . intraoperative hernia presentation was : l1 - 19 ( 31.7% ) , l2 - 16 ( 26.6% ) , m1 - 6 ( 10% ) , m2 - 19 ( 31.7% ) . group a had , l1 - 9 , l2 - 8 , m1 - 3 , m2 - 10 . group b had , l1 - 10 , l2 -8 , m1 - 3 , m2 - 9 ( table 2 ) . preoperative and intraoperative characteristics of inguinal hernias study results and statistical analysis of data showed significant differences in the duration of surgery between methods a the results showed that the duration of surgery by method a was shorter by 5,667 min as compared to method b the intensity of pain evaluated by visual analogue scale ( vas ) was measured on 5 occasions : before surgery , first day after surgery , seventh day after surgery , 1 month and 3 months after surgery . significantly lower pain level was noted in group a after the first and seventh postoperative day , as well as a month after the surgery . mean values of vas the first day after surgery was 3.53 vs. 4.70 , seventh day after surgery 2.23 vs. 3.16 , a month after surgery 0.80 vs.1.56 . these values show significant differences between group a and group b. there was a statistically significant difference in pain intensity between samples first day after surgery ( p = 2.281 e-06 ) . specifically , calculated t - test value ( -5.256 ) is outside of the range which indicates that the null hypothesis ( 2.00 ) for bidirectional test values of arithmetic means in observed populations can not be accepted . in addition to the risk of 5% , working hypothesis stating that there is a statistically significant difference in pain intensity between group a and group b seventh day after surgery ( p = 4.7314 e-06 ) is accepted . measured t - test value ( -5.06 ) is outside of the range which indicates that the null hypothesis ( 2.00 ) for bidirectional test values of arithmetic means in observed populations can not be accepted . based on the obtained results it can be concluded that there is a significant differences in the severity of pain between the two groups seven day after surgery . in addition , based on the obtained results it can be concluded that there is a statistically significant difference in pain intensity between the groups investigated a month after surgery ( p = 7.0051 e-06 ) . measured t - test value ( -6.19 ) is outside of the range which indicates that the null hypothesis ( 2.00 ) for bidirectional test values of arithmetic means in observed populations can not be accepted . there was no statistically significant difference in pain intensity between the two groups three months after surgery ( p = 0.4468 ) . measured t - test value ( -0.7658 ) is outside of the range which indicates that the null hypothesis ( 2.00 ) for bidirectional test values of arithmetic means in observed populations can not be accepted ( figure 2 ) . results obtained by comparing the arithmetic mean of the intensity of pain before surgery ( v11 ) , first day after surgery ( v12 ) , seventh day after surgery ( v13 ) , one month after surgery ( v14 ) and 3 months after surgery ( v15 ) . paresthesia in the area of the surgical wound or scar was significantly lower in group a. peresthesia in the same area was followed for seven days , one month and three months after surgery . the ratio between group a and b was as follows : the seventh day after surgery 13.3 vs. 26% , one month after surgery 6.6 vs. 20% , 3 months after surgery 3.3 vs. 13.3% ( p = 0.035 ) ( figure 3 ) . comparative diagram of paresthesia in studied groups during the early postsurgical phase 17 complications were observed , two in group a ( ecchymosis 1 , seroma 1 ) , and 15 in group b ( ecchymosis 6 , seroma 9 ) . results showed that 28/30 ( 93.3% ) patients from the group a and 15/30 ( 50.0% ) patients from the group b had no complications . therefore , group a had significantly less postsurgical complications than group b. the results obtained by statistical processing of the total number of complications between the two groups , with a calculated p value = 0.024 , indicates a statistically significant difference in the number of complications ( table 3 ) . comparative analysis of the total number of complications in studied groups the results confirmed ( with the risk of 0.05 ) a working hypothesis , according to which there is a statistically significant difference in complications  ecchymosis ( p = 0.048 ) between the surgery method a and method b. the results also confirmed ( with the risk of 0.05 ) the second working hypothesis , according to which there is a statistically significant difference in the proportion of complications  seroma ( p = 0.033 ) between the surgery method a and method b. the results showed that there were no complications such as hematoma and recurrence , and that there is no statistically significant difference in the proportion of these complications between surgery method a and method b ( 4 ) . successful surgical treatment of inguinal hernia implies a low rate of recurrence , permanent relief of pain and discomfort caused by a hernia , as well as a low incidence of postoperative complications . for last fifteen years inguinal hernia surgery by lichtenstein is the first and most widely used open tension - free method . systematic review on the use of fibrin glue in abdominal wall repair showed to be more beneficiary for fixation of polypropylene mesh with fibrin glue than mechanical  suture fixation . the literature analyzed was from : medline , embase , and the cochrane library plus databases . articles found showed randomized clinical trials , non randomized comparative studies and case series that included minimum of 10 patients . in these studies fibrin glue has proven to be biocompatible with the surrounding tissue . in patients treated with fibrin glue , there was a lower prevalence of acute and chronic postoperative pain , and hemorrhagic complications ( 5 ) . our results largely agree with published studies that compared the fixation of the mesh with fibrin glue and suture technique in open inguinal hernia repair by lichtenstein ( 6 ) . data obtained during our research , showed that the use of fibrin glue for fixation of polypropylene mesh in inguinal hernia repair achieved excellent results , with significantly fewer side effects as compared to the conventional method of suture fixation . the results confirmed that the seroma type of complications are significantly less present in fibrin glue fixation methods , while the ecchymosis type of complications are insignificant when using suture techniques . mean surgical time was reduced by 10% in the group where the fixation was performed using fibrin glue . patients in this group had less local hemorrhagic complications ( hematoma , ecchymosis , seroma ) than the patients from the suture group . in the early postoperative period , patients from the fibrin glue group had lower pain intensity and paresthesia ( numbness ) in the groin . the differences in the results after 7 days and 1 month proved to be significant , however , after 3 months they were not significant . paresthesia was more prominent in the suture group even after 3 months , in that way showing a significant difference ( 4 ) . a prospective , multicenter study was designed to compare fibrin glue with conventional suture tissue fixation in inguinal hernia repair by lichtenstein . five hundred and twenty patients were analyzed in whom mesh fixation was performed using fibrin glue ( 349 patients ) or suture ( 171 patients ) . average pain intensity by vas in the preoperative phase was 2.9 , with no significant difference between the groups . surgery parameters were similar between the treated groups , with the exception of the average duration of the surgery . the surgery was shorter in patients where fibrin glue was used ( 55.6 vs. 61.2min , p < 0.001 ) . patients in fibrin group also rarely experienced early local  hemorrhagic  complications ( hematoma , ecchymosis  ) as compared to suture group . after a one - month assessment , patients from the fibrin group reported significantly less pain , paresthesia , and discomfort , as compared to patients from suture group . there was a lower incidence of hematoma ( 1.7 vs. 8.2% ) and ecchymosis ( 8.6 vs. 15.2% ) in patients treated with fibrin glue , as compared to patients in the suture group ( both p = 0.001 ) . the average vas value for pain intensity was significantly lower in the group treated with fibrin glue ( 2.5 vs. 3.2 ; p < 0.001 ) ( 7 ) . one randomized study compared the suture technique , cyanoacrylate glue and fibrin glue as a means of fixation of polypropylene mesh . morbidity in suture group was 38.98% , in the fibrin glue group was 9.62% , and in cyanoacrylate glue group 10.71% ( suture group vs. fibrin glue , p < 0.001 ; suture group vs. cyanoacrylate glue , p < the presented results show that the mesh fixation with fibrin glue in open , tension - free repair by lichtenstein is simple , safe and effective . this method of fixation show distinct advantages over staple fixation , with slight possibility of chronic pain , and complications from the wound recurrence . mesh fixation with fibrin glue is simple procedure that is related to the reduction of postoperative inguinal pain . fixation with glue causes less nerve injuries , the pubic periosteum injuries , or injuries to blood vessels than conventional methods that are associated with iatrogenic tissue trauma and neuropathic pain . during polypropylene mesh fixation with fibrin glue minimal retraction is required . greater retraction , as in suture methods , leads to increased tissue contusion and short - term pain . therefore , consistent with our results , a small contusion of soft tissues associated with minimal postoperative pain is what makes this method more advanced . therefore , fibrin glue can be considered as the first option in the fixation of polypropylene mesh in open inguinal hernia repair .