Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial

Abstract

It is unknown at present what the best method is among mesh implantation, central incision, reconstructing the deep inguinal ring, or a non-incised mesh implant in laparoscopic hernia surgery. Further, it is unproven to what extent a circular enclosure of the cremasteric structures by an incised mesh implant could cause postoperative complications and complaints. To evaluate the possible effects of different configurations and fixation techniques of mesh implants in transperitoneal repair of inguinal hernias, a randomized trial (phase IIIa study) was conducted to compare incised versus non-incised mesh and clip fixation versus suturing the mesh. A total of 360 male patients with unilateral primary hernias were randomized to 3 groups. Postoperative complaints were documented by means of a visual analog scale. These values showed no significant differences between study arms. At the first postoperative control, on day 3, patients after repair of Nyhus type II hernias had significantly fewer complaints than those after Nyhus type IIIa and IIIb repair. To gain additional facts, a duplex flow examination of testicular vessels was performed pre- and postoperatively. Testicular perfusion was not influenced by mesh configurations in the trial. There were no statistical differences in postoperative complications and recurrence rates between groups. In conclusion no influence on postoperative complaints and complications could be demonstrated by different mesh fashioning and fixation alternatives studied in this trial.

Chronic pain after hernia repair: a randomized trial comparing Shouldice, Lichtenstein and TAPP

“…The majority of studies that compare mesh repair with non-mesh repair with regard to postoperative pain, physical activity or early return to work and leisure activities show significantly better results for the tension-free techniques [3, 21,26,37]. However, it is important for one to notice that the difference between Shouldice and the open tension-free Lichtenstein technique is not as evident as that between Shouldice and laparoscopic repair [26,33,38].…”

“…Both open techniques, Shouldice and Lichtenstein, are associated with possible injury to peripheral nerve structures and scarring of the abdominal wall [25]. Nerve injury during laparoscopic hernia repair, especially to the nervus cutaneus femoris lateralis has also been reported, especially at the beginning of the laparoscopic repair era, but seems to be avoidable with the correct operating technique [21]. Tension-free techniques and especially laparoscopic repair, seem to be less painful in the early postoperative period [3, 12,26], but there is no evidence as to whether the presence of the prosthetic mesh itself may be the source of postoperative complaints [3,22,[27][28][29].…”

“…The influence, however, of different surgical techniques remains unclear [3, 4, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

Laparoscopic hernia repair?TAPP or/and TEP?

“…In particular, the protagonists of TEP are interpreting such a renunciation of fixation as an advantage of TEP over TAPP. Some comparative studies presented no fixation or suture fixation as an effective alternative especially for TAPP [25,43]. The reduced material, characteristic for the applied meshes in these studies, could generally also be of significance, as the average rate of recurrence in large patient groups is 1% or less (Tables 1 and 2), depending on the composition of the patient collective that is being investigated.…”

“…Technical details of the TAPP technique were assessed in 12 studies but in only half of them could a relevant question be detected [11]. Similarly to TEP there are indications to use a non-incised mesh [25], which is fixed by most authors depending on the kind of hernia defect and probably also on the type of mesh used [26]. The peritoneal defect must be closed tightly following the placement of the mesh (e.g.…”