When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases

Abstract

Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Hernia Registry. In the period September 01, 2009, to January 31, 2014, 11,228 male patients were operated on with the TAPP technique for a primary unilateral inguinal hernia and were followed up for 1 year. Mesh fixation was used for 7422 (66.1 %) of these patients and no mesh fixation for 3806 patients (33.9 %). Unadjusted analysis did not find any significant difference in the recurrence rate (0.88 % with fixation vs. 1.1 % without fixation; p = 0.259). Multivariable analysis of all potential influence factors (age, ASA, BMI, risk factors, defect size, mesh fixation, localization of defect, mesh size) did not identify any factor that impacted recurrence on 1-year follow-up. Only for medial and combined defect localization versus lateral localization was a highly significant effect identified (p < 0.001). With mesh fixation and larger mesh size, it was possible to significantly reduce the recurrence rate for larger medial hernias in this series (p = 0.046). For TAPP repair of an inguinal hernia, mesh fixation is not necessary in a significant number of patients. Patients with a medial and combined hernia are at higher risk of recurrence. In the patient series analyzed, it was possible to significantly reduce the recurrence rate with mesh fixation and larger mesh size for medial defects.

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

“…These results build on our previously published early experience on this technique . A consistent rate of recurrence in groin hernia repair is difficult to determine in the literature, with a range from 0.88% to 15% being reported . A hernia registry of 11 228 patients revealed a recurrence rate with mesh fixation of 0.88% at 1 year, while no mesh fixation had a recurrence rate of 1.1% without a significant difference in unadjusted analysis .…”

“…A consistent rate of recurrence in groin hernia repair is difficult to determine in the literature, with a range from 0.88% to 15% being reported . A hernia registry of 11 228 patients revealed a recurrence rate with mesh fixation of 0.88% at 1 year, while no mesh fixation had a recurrence rate of 1.1% without a significant difference in unadjusted analysis . A Cochrane systematic review reported a recurrence risk of 4% in non‐mesh repair and 1–3% in mesh repair …”

Transabdominal pre-peritoneal inguinal hernioplasty (TAPP) without mesh fixation. Initial experience in the short term.

“…Actualmente las guías publicadas por sociedades vinculadas a la especialidad recomiendan, tanto para la técnica TEP o eTEP como para el abordaje TAPP, considerar la no fijación de la malla en aquellas hernias tipo L I, II, M I y II de la clasificación de la Sociedad Europea de la Hernia (SEH) [5][6][7] .…”

The Impact of Double Fixation with Titanium Tack and N-Butyl Cyanoacrylate Glue (NBCG) Mesh Fixation versus NBCG Fixation Only in Totally Extra-Peritoneal Hernioplasty with 3-Dimensional Configured Polyester Mesh: A Comparative Study

“…4,6 Fixation of prosthetic mesh with titanium tacks in laparoscopic hernioplasty helps to reduce recurrence. 1,7 However it is reported that it may associate with increase in post-operative pain and discomfort. Therefore numerous studies have been focused on the use of alternative approaches for mesh fixation, such as use of suture or fibrin sealant glue fixation.…”