Laparoscopic totally extra‐peritoneal groin hernia repair with self‐gripping polyester mesh: a series of 780 repairs

Abstract

Background: Laparoscopic groin hernia repair is an increasingly common procedure with benefits of reduced post-operative pain and infection. Post-operative chronic pain remains an ongoing concern in about 10% of patients. Parietex ProGrip™, a polyester self-gripping mesh, has a theoretical benefit of avoiding tacks for mesh-fixation. This case series reflects our long-term experience of this technique. Methods: We conducted a retrospective case series from November 2011 to December 2017. Patients were identified through an operative Medicare Benefits Schedule item number search. Clinical documentation was reviewed with length of stay, mesh infection, chronic pain, recurrence and re-operation as primary data points. Results: A total of 514 patients underwent 780 laparoscopic inguinal hernia repairs with self-gripping polyester mesh during this period. There were 53 female (10.3%) and 461 male patients (89.7%). Unilateral hernia repair was performed in 248 patients (48.2%) and bilateral repair in 266 patients (51.8%). Almost all repairs (779, 99.8%) were primary hernias. There were no mesh infections. Four recurrences were noted (0.51%) and three of these subsequently underwent open redo-hernia repairs (0.38%). Post-operative follow-up was up to 4.4 years. Conclusions: Our series of laparoscopic groin hernia repair with self-gripping mesh demonstrate this is a safe and reliable mesh and effective technique with low recurrence rates.

Outcomes of 207 totally extraperitoneal hernia repairs using self-fixation mesh

“…Common perioperative complication rates in inguinal hernia procedures are low, Stavert et al reported, in 780 laparoscopic inguinal hernia repairs, a complication rate of 0.13–1.67% being seroma (1.41%), hematoma (1.41%) and surgical site infection (SSI) (0.13%) the most frequently found 31 . Results similar to those were found in our study with a slightly higher presence of seroma but no presence of SSI (Seroma 2.1%, hematoma 1.45% and SSI 0%) 21 , 32 , 33 . In terms of SSI, adding clean contaminated procedure to hernia inguinal repair still remains controversial due to believed aggregated risk, nevertheless, as Quezada et al described in 21 patients who underwent concomitant laparoscopic hernia repair and cholecystectomy, we found lower incidence of SSI 34 .…”

“…Both scenarios presented are congruent with reported results in literature, Mitura et al in a study with 1647 patients found that greater pain was reported in patients more active professionally or those who performed heavily manual tasks, as our cases 31 , 43 . In respect of pain, results of our study are affected because a small percentage of patients completed a long time follow up (5 year evaluation), chronic pain is lower compared to similar studies, showing rates of 3.5% (with mesh) and 2.9% (without mesh) 21 , 29 , 36 .…”

“…Recurrence rate, as one of the milestones in hernia surgery follow up, was low (0.7%), equivalent to other self-fixation mesh experience rate (< 1%) reported by Stavert et al Furthermore, recurrence rate found is lower compared to other studies matching different surgical techniques (open, TAPP, TEP) and fixation methods (Invasive, non-invasive, not fixation) with reported rates that may vary between 1 to 15% 4 , 21 , 27 , 30 , 32 , 33 , 39 – 42 . As reported in literature analysis of a non-invasive fixation (self-fixation mesh) technique in our population showed low morbidity preoperatively and in the late follow up 16 , 22 .…”

“…Prosthesis reinforcement of the myopectineal orifice has been constituted as a gold standard approach that shows an important recurrence reduction over time 6 , 24 . Many strategies aiming for pain reduction without altering recurrence rates have been elucidated, being non-invasive fixation methods more frequently suggested as feasible 4 , 17 , 21 , 24 – 28 .…”

“…Furthermore, reduction of postoperative pain can be accomplished by optimizing dissection techniques without increasing recurrence rates and decreasing use of mesh fixation devices when possible 18 , 19 . Besides, to reduce risk of chronic pain associated with suture or tacker fixation, self-adhering, or self-gripping mesh materials (SAMMS) have been developed 19 – 21 . Overall, there are advantages and disadvantages of both TAPP and TEP procedures 6 , 22 .…”