Abstract
Aim of the work: Randomized comparative study comparing outcome of mesh fixation versus non-fixation in TEP technique for inguinal hernia repair. Methods: In Tanta University Hospitals, over the period from February 2015 to October 2017, 58 patients with with 67 inguinal hernias (9 bilateral) undergoing TEP technique were randomized into 2 groups: Group A; mesh fixation 31 patients with 35 hernias. Group B; mesh non-fixation 27 patients with 32 hernias. Follow up was 6-17 months. Results: There was no statistical difference between 2 groups regarding operative time, postoperative complications, length of hospital stay and risk of chronic groin pain. Postoperative pain score was higher in Group A (mesh fixation). There was one case of hernia recurrence in group A (hernia and recurrence were both indirect), however, risk of hernia recurrence was not statistically significant. Conclusion: Mesh fixation and non-fixation in TEP are comparable regarding operative time, complications and hospital stay, while pain score was higher with mesh fixation. Mesh fixation does not increase the risk of chronic groin pain, while non-fixation does not increase hernia recurrence rate. Both techniques were proved safe.
Highlights
More difficult to master, there are several advantages of the Totally Extraperitoneal (TEP) repair as compared to open techniques of inguinal hernioplasty
Despite the long period since Totally Extraperitoneal (TEP) approach was first described by McKernan and Laws in 1993, there is still debate about the clinical significance of mesh fixation
This prospective study was conducted at General Surgery Department, Tanta University Hospitals, Egypt during the period from February 2015 to October 2017. 58 patients were randomized into 2 groups: Group A included 31 patients (4 bilateral cases giving total of 35 hernias) in which TEP was done with mesh fixation, while Group B included 27 patients (5 bilateral cases giving total of 32 hernias) in which TEP was done without mesh fixation
Summary
More difficult to master, there are several advantages of the TEP repair as compared to open techniques of inguinal hernioplasty. TEP has less postoperative pain with shorter convalescence, fewer hematomas, and deep space infections while the recurrence rates remain nearly equal to open techniques [1]. Some studies comparing different types of meshes and fixation methods revealed that non-fixation of mesh had higher rate of mesh migration [2]. Others said that mesh fixation does not add strength to the repair and its purpose is to prevent mesh displacement during first 24 -48 hours [3, 4]. Despite the long period since Totally Extraperitoneal (TEP) approach was first described by McKernan and Laws in 1993, there is still debate about the clinical significance of mesh fixation
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