Are There Differences in Chronic Pain After Laparoscopic Inguinal Hernia Repair Using the Transabdominal Technique Comparing With Fixation of the Mesh With Staples, With Glue or Without Fixation? A Clinical Randomized, Double-Blind Trial

Abstract

BACKGROUND: Regarding postoperative pain, it remains unclear whether non-fixation of the polypropylene prosthesis in transabdominal preperitoneal inguinal hernia repair produces the same outcomes as mesh fixation with glue or tackers. In addition, hernia recurrence is another aspect to be assessed in the comparison between non-fixation and mesh-fixation techniques (tackers and glue). AIMS: This study aimed to evaluate the incidence, quality of pain, and recurrence in patients undergoing laparoscopic inguinal hernioplasty (transabdominal preperitoneal) technique, comparing the fixation of the mesh with tackers versus with glue versus without fixation. METHODS: This is a prospective, double-blind study in which 63 patients presenting with primary unilateral inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal hernia repair and were randomized into three groups: no mesh fixation (n=21), mesh tacked (n=21), and mesh fixed with fibrin glue (n=21). Patients also responded to questionnaires in order to assess pain and pain quality and were followed up for 2 years. RESULTS: Neither mesh-fixation nor non-fixation techniques were found to affect postoperative chronic pain (p=0.535), but patients undergoing tacker fixation reported more pain descriptors (p=0.0021) and a higher pain index (p=0.002) on the McGill scale in the first 15 postoperative days (T0 and T1). No hernia recurrences were observed. CONCLUSIONS: Both mesh-fixation techniques (tackers and glue) used with the transabdominal preperitoneal approach did not influence the onset of inguinodynia, but tacker fixation was more likely to increase patient sensitivity to pain. Mesh placement without fixation produced the same pain and recurrence outcomes as mesh-fixation techniques. Also, no recurrence was observed in patients without mesh fixation in this study. Consequently, it has become an alternative therapy deserving consideration for hernia repair.

In vivo comparison of mesh fixation solutions in open and laparoscopic procedures for inguinal hernia repair: A meta-analysis

“…Early and chronic pain are elements of interest to evaluate the effects of different mesh fixation techniques. All the chosen papers analysed these aspects, but in particular 3 reported data related to early pain in OS [ 31 , 34 , 35 ] and 4 related to early pain in LS [ 31 , 43 , 44 , 46 ], 8 studies reported data related to chronic pain in OS [ 21 , [31] , [32] , [33] , [35] , [36] , [37] , 45 ] and 5 reported data on chronic pain in LS [ 25 , 31 , 39 , 43 , 46 ]. Patients were asked to record pain scores 12 or 24 h after the surgical procedure using the VAS index.…”

Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy

“…The reasons for exclusion are outlined in Figures 1, 4. Subsequently, four additional studies (15, 19,33,34) were incorporated into the synthesis, along with 16 studies from previous meta-analyses (17,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), particularly the one conducted by Nan Hu et al (20). In total, this metaanalysis included a total of 20 articles (15, 17,19,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49].…”

“…Subsequently, four additional studies (15, 19,33,34) were incorporated into the synthesis, along with 16 studies from previous meta-analyses (17,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), particularly the one conducted by Nan Hu et al (20). In total, this metaanalysis included a total of 20 articles (15, 17,19,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. The collective sample involves 2,928 patients with inguinal hernias, distributed as 1,582 in the TMF group and 1,346 in the GMF group, meeting the inclusion and exclusion criteria.…”

“…The study conducted by Nizam et al (17) demonstrated that the fibrin glue method proved to be a cost-effective approach that resulted in a reduced hospital stay compared with the TMF group. The GMF method has also reduced the risk of inguinodynia and recurrence in randomized controlled trials (RCTs) over comparative groups (18,19).…”

Hernia Mesh Fixation

“…In clinical practice, the techniques for keeping mesh in place can be categorized as no mesh fixation and mesh fixation. No mesh fixation is the method used for laparoscopic inguinal hernias, as reported both in TEP [18][19][20] and TAPP [21][22][23]. At the end of the surgical procedure, expelling the air allows the peritoneum to attach to the mesh, while intra-abdominal pressure causes the extraperitoneal space to naturally close and constrict, allowing the mesh to be fixed in position.…”