Comparison of totally extraperitoneal groin hernia repair with and without mesh fixation

Abstract

INTRODUCTION: Since the introduction of the laparoscopic technique for tension-free inguinal hernia repair, various mesh fixation techniques have been adopted. The need for mesh fixation during the surgery is still under debate. We conducted our study to compare the outcomes of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair with (MF) and without (NMF) mesh fixation. PATIENTS AND METHODS: One hundred and fifty-seven patients underwent laparoscopic inguinal hernia repair without mesh fixation during 2010–2014. Of these, 113 (71.9%) agreed to participate in our trial, underwent physical examination, and filled out a questionnaire regarding their satisfaction with the surgery outcome. The data collected from medical records and results of the examination and the questionnaire were processed statistically and compared to the results of a previous study, which included patients who underwent TEP with mesh fixation. RESULTS: Mean follow-up was about 3 years in both groups. Duration of procedure and length of hospital stay were shorter in the NMF group. Patients without mesh fixation had less pain and earlier return to work and physical activity. There was no significant difference in recurrence rate between NMF and MF groups (5.6% and 4.6%, respectively). The majority of recurrences in the MF group were among patients in whom a nonsplit mesh was used. Surgery satisfaction, however, was significantly higher in the MF group. CONCLUSION: TEP without mesh fixation results in better surgical and postoperative outcome comparing with mesh fixation. Overall hernia recurrence rate was similar in patients with and without mesh fixation. Regular follow-up of at least 18 months is recommended to define true recurrence rate.