Abstract
One of the most serious complications after inguinal hernia repair is still the occurrence of chronic pain. The literature describes rates of severe chronic pain of 3%-6%. Laparo-endoscopic inguinal hernia repair is favored to prevent postoperative pain through a minimally invasive approach and sparing of the layers of tissue covering nerves and vessels in terms of reduced risk of damage to these structures. However, the method of fixation of the mesh is still controversial discussed. The use of these penetrating devices such as staples and staplers has been shown to often be complicated by injury to nerves and vessels and occurrence of postoperative pain. The shift to completely atraumatic fixation using adhesives (fibrin glue, cyanoacrylate) began in the early part of this century. Several studies confirmed less postoperative pain after mesh fixation by glue compared to stapler or tacker. Historically, the TEP technique has always been performed without any fixation. Several studies comparing fixation versus non-fixation have been performed in TEP repair and found results with no increase in recurrence rate. Notwithstanding that very few studies comparing fixation versus no fixation with exclusion of large medial inguinal hernias have been published on this topic in TAPP repair, identical results to those with TEP repair were obtained. On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair except for large medial and combined inguinal hernias. If mesh fixation is required, atraumatic techniques should be used.
Highlights
Since the introduction of minimally invasive techniques in inguinal hernia surgery with TAPP[1] and TEP[2], www.misjournal.netFortelny
On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair except for large medial and combined inguinal hernias
The conclusion of this study suggests that non-fixation in TEP repair does not carry a risk of recurrence even in medial hernias
Summary
Since the introduction of minimally invasive techniques in inguinal hernia surgery with TAPP[1] and TEP[2],. The results of a RCT by Zhu et al.[11] showed a significantly reduced incidence and volume of seroma formation without increasing the risk of recurrence, acute and chronic pain In another prospective study by Usmani et al.[12] comparing direct defect closure in MII and MIII inguinal hernias by barbed non-resorbable suture versus non-closure in TEP and TAPP repair demonstrated a statistically significant reduction in seroma formation (12.6% vs 6.4%, P = 0.045) and in recurrence (4.4% vs 0.9%, P = 0.036) after a follow-up of at least 9 months. The risk factor for chronic pain was a postoperative complication In this registry study of TEP repair in male patients, a low incidence of recurrence was observed with no significant difference seen in non fixation, permanent and glue fixation. The lowest common denominator for low-risk non-fixation of meshes in TEP and TAPP techniques seems to be primary unilateral male inguinal hernias with exclusion of medial hernia types with a defect diameter of ≥ 3 cm
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