Abstract
Background: It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, and port-site hernia. We chose to fix it to the exterior reducing port size, cost and pain, at the same comparing this with traditional mesh stapling. Methods: We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair on 120 patients in which we fixed the mesh to the anterior abdominal wall using either two prolene threads that passed to the exterior and tied in place or traditional mesh stapling. Results: The operative time is ranged from 35 to 70 minutes for external fixation, 30 to 60 minutes for mesh stapling, and 4 to 51 months for follow-up, and no recurrence occurred in both groups during the procedure. Two cases with post TAPP pain in mesh stapling patients are discussed with reduction of the cost and port size in external fixation patients. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior and it is fixed only to the exterior allowing a reduction in size of the ports and considerable reduction in cost with elimination of TAPP associated post operative pain.
Highlights
3500 years ago, Egyptian physicians reported the management of hernia by conservative means including the snuggly fitting bandage for reduction and support
The time of surgery ranged from 35 minutes to 70 minutes from the first incision until the last suture in the external fixation group of patients, on the stapled mesh group of patients ranged from 30 - 60 minutes
The port sizes are reduced in external fixation group of patients with considerable reduction in the cost
Summary
3500 years ago, Egyptian physicians reported the management of hernia by conservative means including the snuggly fitting bandage for reduction and support. Several studies have demonstrated a definite advantage over open repair with regard to reduced postoperative pain [3,4,5] and earlier return to work and normal activities [6,7,8]. It is unknown at present what the best method is among mesh implantation, central incision, reconstructing the deep inguinal ring, or a non-incised mesh implant in laparoscopic hernia surgery [9]. That is why we tried to find out a way that can eliminate the use of expensive devices to reduce the cost without affecting the outcome
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