Laparoscopic Total Extraperitoneal Hernia Repair: Mesh Fixation Is Unnecessary

INTRODUCTIONInguinal hernia affects both men and women but is much more common in men who comprise over 90% of operated patients. 1 Considering both operated and nonoperated inguinal hernias, the lifetime prevalence rate is 47% for men up to and including the age of 75.2 From an aetiological point of view there are two types of inguinal hernia, congenital and acquired. An acquired inguinal hernia is generally not believed to be associated with a persistent processus vaginalis but develops in a secondary manner. Several risk factors for the development of this type of hernia have been suggested, among these various connective tissue factors. In order to compare the results of inguinal hernia repair, a standardized classification with respect to localisation and size is needed. Several classifications exist, of which the Nyhus classification is one of the most commonly used. 3Hernias can only be cured by surgery. The aim is to reduce the patient's symptoms and prevent possible negative events such as incarceration without causing ABSTRACT Background: Inguinal hernia affects both men and women but is much more common in men who comprise over 90% of operated patients. The purpose of this study was to determine whether elimination of tacking the mesh during endoscopic inguinal hernia repair results in decreased postoperative pain or complications, or both, without increasing the incidence of hernia recurrence. Methods: Patients age between 18 to 70 yrs, willing for laparoscopic surgery, suitable for elective laparoscopic surgery were included in the study. TEP or TAPP endoscopic inguinal hernia repairs would be performed with the patient under general anesthesia. Data collection have done by using a structured pre-prepared case performa. The patient evaluated both by radiological and laboratory investigations both pre-operatively and post-operatively. Results: There is no major significant difference in pain at 1 month after operation in both the group. Recurrence was higher among patient having mesh fixation and it was not statistically significant. Wound infection was occurring more among without fixation group and it was not statistically significant. Urinary retention was reported more among without fixation group and it was not statistically significant. Conclusions: Thus, it was concluded that there is no significant difference in recurrence rate in the both study group either with fixation or without fixation. There is no significant difference in pain at one month in the both study group either with fixation or without fixation. There is more pain (visual analogue scale more than two) at three months after operation in fixation group as compared to without fixation group. There is also high cost in fixation group as compared to without fixation group.

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“…8 We observed post-operative pain at 1 month and at 3 month. We used visual analogue scale for measurement of pain.…”

Section: Discussionmentioning

confidence: 78%

Evaluation of recurrence and postoperative pain in laparoscopic inguinal hernia repair with mesh fixation verses without mesh fixation

2018

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“…To date, the series reporting the lowest postoperative chronic pain rates have not used any means of mesh fixation. 34,35,52 Tamme et al 52 and Beattie et al 34 observed 2.55 and 0% chronic pain problems, respectively, after TEP repair, with a recurrence rate of less than 0.6%. However, the largest of these two series did not specify the length of follow-up and the other one was a rather small series (n = 89).…”

Section: Discussionmentioning

confidence: 98%

“…42 Besides nerve damage during dissection, thermal injury due to electrocautery, and inflammatory and/or mechanical reaction to the mesh, stapling of the mesh is the most frequent evocated mechanism. 34,45,48 Among other potential factors causing postoperative pain is the repair of recurrent hernias. There is a great variation in the rate of postoperative chronic pain, ranging from 0.1 to 0.4% and 22.5% 41,45,49 in laparoscopic repairs for which staples are used to attach the mesh.…”

Section: Discussionmentioning

confidence: 99%

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

Shinde¹

2009

WJOLS

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Background: Laparoscopic fixation of meshes prior to their fibrous incorporation should be reliable to minimize recurrences following transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal repair (TEP) repair of inguinal hernias. However, suture, tack and staple-based fixation systems are associated with postoperative chronic inguinal pain. Initial fixation with fibrin sealant offers an atraumatic alternative, but there is little data showing that fibrin-based mesh adhesion provides adequate biomechanical stability for repair of inguinal hernia by TAPP and TEP.Methods: A literature search was performed using medline and the search Google, Springer link and Highwire press. The following search terms were used: Laparoscopic hernia mesh, Fibrin glue, and Tackers. 2293 citations were found in total.Selected papers were screened for further references. Criteria for selection of literature were the number of cases (excluded if less than 80), methods of analysis (statistical or nonstatistical), operative procedure (only universally accepted procedures were selected) and the institution where the study was done (specialized institution for laparoscopic surgery).Results: Mesh fixation has always invited lots of interest amongst surgeons and instrument companies due to the wide range of postoperative complications each of them caused. TAPP and TEP usually involves fixation of mesh, however many studies challenging the mesh fixation in TEP are being published. There are two most common methods of fixing mesh using fibrin glue (Tissucol) and tackers. Fibrin sealant possesses both mechanical strength and elasticity. Overall, data from previous studies, shows that mesh stability with fibrin sealant fixation is at least equivalent to suture fixation, indicating that fibrin sealant could be considered the fixation method of choice in inguinal hernia repair. This new method of mesh fixation is obviously potentially less harmful than stapling the mesh and can help reduce the risk of chronic postoperative pain at a comparative or even lower cost than a stapling device. Conclusions:Fibrin glue gives an adequate mesh fixation with a less chance of chronic postoperative pain. It appears to be an alternative to staples and may help reduce the postoperative pain problems after hernia repair. All methods give the same results in terms of recurrence rate, hospital stay, and costs; but with better results in terms of postoperative pain, seromas, and trocar-related trauma. However the use of fibrin glue needs extensive study, as the anatomical dissection and inguinal region preparation have to be carefully performed, and the mesh size has to be adequate; peritoneum closure with a running suture is more time consuming. Large randomized trials and longer follow-up are required to demonstrate the advantages of either technique.

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“…In both the above mentioned techniques, the hernia sac is reduced, and a large piece of mesh is used to cover the entire inguinal region. Metal staples can be used to hold the mesh in place, however some surgeons believe this is an unnecessary step because it increases costs and also risks due to the possibility of nerve entrapment (31,32). As an alternative to stapling or suturing, the use of fibrin glue can also be explored as a potential option (8,33).…”

Section: Group 4: Laparoscopic Proceduresmentioning

confidence: 99%

Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada

Malik

Bell

Stukel

et al. 2012

Journal of the American College of Surgeons

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Laparoscopic Total Extraperitoneal Hernia Repair: Mesh Fixation Is Unnecessary

Abstract: Our experience suggests that mechanically fixing the mesh in the preperitoneal space is unnecessary. Not fixing the mesh avoids possible complications and is not associated with any increased risk of hernia recurrence.

Cited by 85 publications

References 8 publications

Evaluation of recurrence and postoperative pain in laparoscopic inguinal hernia repair with mesh fixation verses without mesh fixation

Evaluation of recurrence and postoperative pain in laparoscopic inguinal hernia repair with mesh fixation verses without mesh fixation

Fibrin Sealant versus Use of Tackers for Fixation of Mesh in Laparoscopic Inguinal Hernia Repair

Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada

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