Purpose <p>Traditional mesh fixation using tacks in laparoscopic repair of lateral incisional hernias (IHs) carries risks near sensitive anatomical areas. This retrospective cohort study evaluates the efficacy and safety of NBCA (n-butyl-2-cyanoacrylate) surgical glue as an alternative to tacks for mesh fixation.</p> Methods <p>Patients with primary lateral primary incisional hernias who were treated by laparoscopic technique in Department of Hernia and Abdominal Wall Surgery in Beijing Chaoyang Hospital from Jan 2017 to Dec 2023 were recruited in our study. Patients were divided into two groups: surgical glue with tacks group (GT, n=72) and tacks only group (TO, n=72). Demographics, operative details, hematoma, seroma, chronic pain, recurrence and other complications were retrospectively compared between the two groups.</p> Results <p>A total of 144 patients were recruited in our study. According to different fixation, there were 72 patients in GT group and 72 in TO group. Compared to TO group, the GT group had a significantly lower postoperative pain score at 24 hours, 72 hours and 120 hours(4.0vs.3.0, 3.0vs.2.0, 2.0vs.1.0, respectively, P&lt;0.001). The recurrence was similar between the two group(2.7%vs.2.7%, respectively, P&gt;0.05). GT group had a quicker time to return to normal activities(7vs.11days, respectively, P&lt;0.001). The overall complication rates were equivalent between the two groups (9.7% vs.19.4%, respectively, P&gt;0.05).</p> Conclusion <p>NBCA surgical glue may provide certain clinical advantages in laparoscopic lateral IH repair, including reduced postoperative pain and faster recovery, although the magnitude of pain reduction is modest. Glue-assisted fixation appears safe and does not increase recurrence or complication rates. Its use may be particularly beneficial in anatomically sensitive regions where traditional fixation poses higher risks. Further prospective multicenter studies are needed to confirm its long-term safety and effectiveness.</p>