Laparoscopic Repair of Bilateral Inguinal Hernia Using Large Butterfly Mesh Without Fixation Versus Double Meshes with Stapler Fixation through TAPP Approach

Abstract

Background: Inguinal hernia repair is one of the most frequent elective operations performed in general surgical practice. Approximately 20% to 30% of patients with inguinal hernia present with bilateral hernias at diagnosis. Objectives: The aim of this study was to demonstrate the outcome between using a single large butterfly mesh without fixation to Strengthen the posterior wall versus the use of two separate meshes with stapler fixation during laparoscopic repair of bilateral inguinal hernia with TAPP technique. Patients and Methods: A prospective randomized comparative study that was conducted in General Surgery Department, Al-Hussein University Hospital, Faculty of Medicine, Al-Azhar University from January 2017 to December 2018. A total of 40 patients with bilateral non-complicated inguinal hernias were included in this study. The patients were subsequently divided into two comparable groups. Group A: Twenty patients were scheduled for TAPP repair with double meshes and tacker fixation. Group B: Twenty patients were scheduled for TAPP repair with a single large mesh without fixation. Results: Average operating time was 102 minutes in group A, and 72 minutes in group B. Postoperative pain was less in group B. One patient had transient hematuria in group B. There was one recurrence in group A on the left side after 8 months and no recurrences were demonstrated in group B. Conclusion: laparoscopic TAPP using a single large butterfly mesh is safe, time saving and cost-effective approach for non-complicated bilateral inguinal hernias, especially in patients with direct hernia, large defect and low BMI.