Positioning of mesh implants in endoscopic inguinal hernia repair

Abstract

To improve the results of endoscopic inguinal hernia repair by determining the optimal access to inguinal region and method of positioning of the mesh implant. There were 221 patients with inguinal hernia who underwent 278 operations. We formed 2 groups: the main group A consisted of 92 (41.6%) patients who underwent extraperitoneal interventions (TEP/e-TEP); the control group B - 129 (58.4%) patients after transabdominal surgery (TAPP). In each group, 3 subgroups were identified depending on the method of mesh implant positioning: subgroups A1 and B1 - stapler reduced fixation at 1-3 points, subgroups A2 and B2 - glue fixation, subgroups A3 and B3 - vacuum positioning without fixation. Acute, chronic pain syndrome and quality of life were evaluated using visual-analogue scale (VAS), Short-Form Inguinal Pain Questionnaire (sf-IPQ) and SF-36 questionnaire, respectively. All interventions were completed in minimally invasive fashion. Regression of acute pain syndrome after 3, 24, 48, 72 hours and 7 days was as follows: in group A - from 3.39±0.37 to 0.53±0.18 scores, in group B - from 4.47±0.34 to 0.94±0.24 scores. The lowest values were observed in subgroups with non-invasive positioning (p<0.05). Chronic pain syndrome was evaluated by all patients as less than 2 scores in 6 months after surgery. SF-36 values after 6 months ranged from 78±1.5 to 92±1.0 at TEP/e-TEP and from 75±1.6 to 92±1.1 at TAPP. Between-group and within-group differences were not significant (p>0.05). Control examination within 0.5-2 years was performed in 189 (85.5%) patients. No relapses were detected. E-TEP technology is a priority. Glue fixation increases the congruence of mesh implants with inguinal region due to enlarged area of immobilization. This ensures safety and reliability of hernia repair, comfort for patients.