Preperitoneal Surgery Using a Self-Adhesive Mesh for Inguinal Hernia Repair

Abstract

Background and Objectives:Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh.Methods:This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed.Results:Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m2. Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome.Conclusion:The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction.

Estado actual de los adhesivos en la cirugía de hernia

“…Una gran operación si está bien hecha, pero que está ensombrecida por su mayor incidencia de dolor crónico posoperatorio. Hay pruebas suficientes de que la fijación con pegamento de la malla se asocia con menos dolor posoperatorio que la fijación con sutura clásica, hace que el procedimiento sea más rápido y no aumenta la tasa de recurrencia [2][3][4][5] . «El pegamento puede ser una alternativa sensata a la sutura para la fijación con la malla en la hernioplastia inguinal de Lichtenstein», como dicen los autores de una gran revisión sistemática.…”