Total Extraperitoneal Laparoscopic Inguinal Hernia Repair Without Mesh Fixation

Abstract

To determine the outcomes of patients undergoing total extraperitoneal inguinal hernia repair without fixation of the mesh. Prospective cohort. Community teaching hospital. A total of 274 consecutive patients were included in the study group. All operations were performed by the same surgeon with the patients under general anesthesia in an outpatient setting. A preformed polyester mesh (Parietex; Covidien, Mansfield, Massachusetts) was used in all cases without any fixation. All patients were prospectively followed up at 2 weeks, 1 month, and 1 year after surgery. Operative morbidity, chronic pain, and hernia recurrence were recorded. Two hundred seventy-four consecutive patients underwent 311 total extraperitoneal inguinal hernia repairs. No conversions were made to open hernia repairs. No recurrences were found at the 12-month follow-up visit. There were 19 inguinal seromas (6.1%) identified at 2 weeks, but only 7 (1.9%) remained at 1 month, and none at 1 year. No wound infections, scrotal hematomas, or other perioperative complications were reported. Two hundred thirty-six patients used fewer than the 30 prescribed tablets for pain control, while 23 patients requested a refill, 12 of whom had seromas (P < .01). At 12 months, no patient was taking pain relief medication; however, 8 patients reported occasional discomfort in the groin, and 1 patient reported occasional umbilical discomfort. This single general surgeon experience supports total extraperitoneal inguinal hernia repair without mesh fixation as a safe, effective procedure with low morbidity and no evidence of recurrence at the 1-year follow-up visit.