Method Of Mesh Fixation Research Articles

SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair

Abstract Aims To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation. Methods 545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair. Results 545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence. Conclusion Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.

Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials.

There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% -34.31- -17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24h and one week.

Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh

BackgroundThe mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. MethodsWe designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. ResultsThe evaluated patients’ median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. ConclusionsSelf-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

Comparison of single absorbable tacker vs. conventional method in fixating the mesh in bilateral inguinal hernia undergoing laparoscopic transabdominal preperitoneal (TAPP): A randomized control trial study

Abstract Background: The current study aims to investigate the superior mesh fixation method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach. Materials and Methods: The current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbable tacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All patients were assessed during the hospital stay and 1 month postoperatively to assess the surgery-associated complications and days for return to daily activity. Eura-Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12-month follow-up. Results: The duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P &lt; 0.001). Only a patient in Group C represented hematoma (P = 0.494). Seroma incidence was not statistically different between the two groups (P = 0.712). Postoperative pain was statistically less in Group S (P &lt; 0.001 for all the assessments). Postoperative QOL within a year after hernia repair revealed an insignificant difference between the groups in general (P &gt; 0.05); however, a pain subscale was significantly less in Group S (P = 0.002). Conclusion: Based on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre- and postoperative complications. However, the two methods did not differ regarding 1-year follow-up QOL.

Laparoscopic versus robotic TAPP/TEP inguinal hernia repair: a multicenter, propensity score weighted study.

The objective of this retrospective study was to assess safety and comparative clinical effectiveness of laparoscopic inguinal hernia repair (LIHR) and robot-assisted inguinal hernia repair (RIHR) from multi-institutional experience in Taiwan. Medical records from a total of eight hospitals were retrospectively collected and analyzed. Patients primarily diagnosed of inguinal hernia, recurrent inguinal hernia or incarceration groin hernia patients who either underwent laparoscopic or robot-assisted inguinal hernia repair between January 2018 and December 2022 were included in the study. Baseline characteristics, intra-operative and post-operative results were analyzed. To compare two cohorts, overlap weighting was employed to balance the significant inter-group differences. We also conducted subgroup analyses by state of a hernia (primary or recurrent/incarceration) and laterality (unilateral or bilateral) that indicated complexity of surgery. A total of 1,080 patients who underwent minimally invasive inguinal hernia repair from 8 hospitals across Taiwan were collected. Following the application of inclusion criteria, there were 279 patients received RIHR and 763 patients received LIHR. In the baseline analysis, RIHR was more often performed in recurrent/incarceration (RIHR 18.6% vs LIHR 10.3%, p = 0.001) and bilateral cases (RIHR 81.4 vs LIHR 58.3, p < 0.001). Suturing was dominant mesh fixation method in RIHR (RIHR 81% vs LIHR 35.8%, p < 0.001). More overweight patients were treated with RIHR (RIHR 58.8% vs LIHR 48.9%, p = 0.006). After overlap weighting, there were no significant difference in intraoperative and post-operative complications between RIHR and LIHR. Reoperation and prescription rates of pain medication (opioid) were significantly lower in RIHR than LIHR in overall group comparison (reoperation: RIHR 0% vs. LIHR 2.9%, p = 0.016) (Opioid prescription: RIHR 3.34mg vs LIHR 10.82mg, p = 0.001) while operation time was significantly longer in RIHR (OR time: RIHR 155.27min vs LIHR 95.30min, p < 0.001). This real-world experience suggested that RIHR is a safe, and feasible option with comparable intra-operative and post-operative outcomes to LHIR. In our study, RIHR showed technical advantages in more complicated hernia cases with yielding to lower reoperation rates, and less opioid use.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

Cover Image

The cover image is based on the Original Article A minimally invasive method for titanium mesh fixation with resorbable sutures in guided bone regeneration: A retrospective study by Songhang Li DDS et al., https://doi.org/10.1111/cid.13147. image

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair.

Laparoscopic incisional hernia repair using intraperitoneal onlay mesh (IPOM) is one of the most widely used minimally invasive methods for repairing incisional hernias. The laparoscopic IPOM involves implanting the mesh into the abdominal cavity through laparoscopy to repair an abdominal wall hernia. In the IPOM surgery, after the closure of the hernia ring, an anti-adhesion mesh is placed laparoscopically. The correct placement of this mesh is critical to the success of the method, and surgical skills are required to achieve perfect placement. If the mesh placement is not mastered properly, the operation and anesthesia time will be prolonged. In addition, improper placement of the mesh can lead to serious consequences, such as intestinal obstruction and mesh infection. A "contraposition and alignment" mesh fixation method is described in this study, which involves pre-marking the fixation position of the mesh to reduce the difficulty of mesh placement. A properly placed mesh is completely flat on the peritoneum, the edges are not curled or wrapped, and the mesh is adhered firmly such that there is no displacement after removing the pneumoperitoneum pressure. The "contraposition and alignment" mesh fixation technique offers the advantages of reliable placement of the mesh and fewer complications than other techniques, and it is easy to learn and master. It also allows for positioning the nail gun in advance based on the anatomy of the incisional hernia. This enables the use of the minimum number of nails possible while still ensuring good fixation, which can reduce the occurrence of complications and reduce the cost of surgery. Thus, the mesh fixation method described here is highly suitable for clinical applications based on the aforementioned advantages.

Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

Application New Mesh Fixation Method Laparoscopic Incisional Hernia - Video. JoVE publishes peer-reviewed scientific video protocols to accelerate biological, medical, chemical and physical research. Watch our scientific video articles. JoVE is the world-leading producer and provider of science videos with the mission to improve scientific research, scientific journals, and education. Millions of scientists, educators and students at thousands of universities, colleges, hospitals and biopharmaceutical companies worldwide use JoVE for their research, teaching and learning.

An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle.

Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM). Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018-March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP). Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1day (0-12), and the median follow-up was 103days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5days (10-523), with two reported hernia recurrences. Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM.

A minimally invasive method for titanium mesh fixation with resorbable sutures in guided bone regeneration: A retrospective study.

Titanium mesh has become a mainstream choice for guided bone regeneration (GBR) owing to its excellent space maintenance. However, the traditional fixation method using titanium screws impacts surgery efficiency and increases patient trauma. We report a novel method of fixing a titanium mesh using resorbable sutures. We assessed the feasibility of resorbable sutures for fixing a titanium mesh and whether it can serve as a stable, universal, and minimally invasive fixation method for a broader application of titanium meshes. Patients undergoing GBR with a digital titanium mesh fixed using titanium screws (TS group) and resorbable sutures (RS group) were observed at different time points. The stability of the fixation methods was evaluated on parameters such as titanium mesh spatial displacement, bone augmentation, and bone resorption. A total of 36 patients were included in this study. The exposure rate of the titanium mesh in the TS group was 16.67%, while no exposure was noted in the RS group. There was no significant difference in the parameters of titanium mesh spatial displacement, bone augmentation, and bone resorption between the two groups (p > 0.05). The use of resorbable sutures for fixing a titanium mesh can achieve similar results to traditional fixation using titanium screws. Although this new fixation method can improve the efficiency of the surgery and reduce the risk of complications, the long-term clinical effects require further follow-up investigation.

OC-015 PATIENT REPORTED OUTCOMES FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN A DISTRICT GENERAL HOSPITAL USING TWO DIFFERENT METHODS OF MESH FIXATION

Abstract Aim Post-operative pain is recognised as an important outcome following mesh repair of groin hernias. We investigated patient reported outcomes using the Carolinas Comfort Scale (CCS) in patients who underwent laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair in a district general hospital (DGH). Methods The CCS questionnaire was sent to 162 randomly selected patients who underwent groin hernia repair (TAPP), performed using absorbable tacks or tissue glue to fix the mesh, by a single surgeon between 2011–2021. The questionnaire is used to assess 23 patient reported parameters including sensation of mesh, pain &amp; movement limitations in different positions e.g. laying, standing etc. The follow-up ranged between 3 months to 10 years. The median and range values for each criterion were used to determine the outcome. Results Seventy-six responses were received (response rate 46.91%). Our data showed excellent outcomes in all parameters measured by the CCS, with a median score of 0 out of 5. There were no hospital readmissions within 30 days or major complications. Out of 1748 measured parameters across 76 patients, only 71 scores were ≥3 (4.06%) – there was no observable correlation between these higher scores and mesh fixation device used. Conclusions In this study we found that it is possible to achieve excellent outcomes in a DGH following laparoscopic groin hernia repair. Initial assessment has not shown any significant difference in outcome between methods of mesh fixation but we wish to study this further with inclusion of more patient reported outcomes.

P-008 PRELIMINARY RESULTS OF A RANDOMIZED CLINICAL TRIAL COMPARING TWO DIFFERENT MESH FIXATION TECHNIQUES IN OPEN RETROMUSCULAR VENTRAL HERNIA REPAIR

Abstract Aim Retromuscular ventral hernia repair has become very popular recently due to its very promising results concerning recurrence and other complications. However, controversy exists regarding the optimal mesh fixation method. The aim of this study is to compare the safety and effectiveness of two mesh fixation techniques. Material &amp; Methods This is an ongoing randomized, prospective, single-blind study. According to study protocol, patients with midline ventral hernias who meet the inclusion criteria, undergo open retromuscular hernia repair and the mesh is fixed either with transfascial sutures or with n-butyl-2-cyanoacrylate glue. In the three-month follow-up patients answer the EuraHS QoL score to assess postoperative pain and other QoL features and are examined for the identification of postoperative complications. The results of the first 20 patients who have completed the three-month follow-up are presented. Results Glue group had an average VAS pain at the site of the hernia of 0.3/10, 0.9/10 and 0.3/10, in rest, during activities, and during last week, respectively, while suture group had 0.3/10, 1.1/10 and 0.6/10, respectively. Concerning the restrictions of daily activities: inside, outside the house, during sports and during heavy labor, glue group had 0.2/10, 0.3/10, 0.6/10 and 1/10 and suture group 0.2/10, 0.4/10, 0.9/10 and 1.1/10, respectively. All differences between groups were not statistically significant. Regarding postoperative complications, only one patient from the suture group presented with seroma. Conclusions The preliminary results slightly favor the glue group, without reaching statistical significance. Retromuscular hernia repair leads to very good early results concerning pain and other complications.

Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia

Introduction: The advent of laparoscopic techniques in repairing inguinal hernia has significantly improved outcomes of inguinal hernia surgery. However, acute and chronic postoperative pain after fixation of mesh with tacks and the cost of tacking devices are major hindrances to the widespread use of laparoscopic transabdominal preperitoneal (TAPP) repair in resource-poor settings. This study sought to introduce a method of mesh fixation that will reduce the cost of laparoscopic TAPP repair and might help reduce postoperative pain.Objective: To compare outcomes in the early postoperative period like pain, seroma, hematoma, urinary retention, and neuralgia after fixation with suture versus the tack fixation of mesh in laparoscopic TAPP repair of inguinal hernia. Subjects and methods: This study was conducted from 1st June 2019 to 31st May 2020. A total of 144 patients between ages 18 and 60 years with an inguinal hernia on any side and having an American Society of Anaesthesiologists (ASA) score of I/II were included in this study. Patients with a recurrent hernia, large scrotal hernia, strangulated and obstructed hernias, ASA III and ASA IV, prostatism, and chronic cough were excluded. Seventy-two patients were in Group A (tack fixation group) while 72 were in Group B (suture fixation group). Separate investigators were assigned to collect pre-operative and post-operative data from both groups, recorded on specially designed proforma.Results: The age range was 18 to 60 years with a mean age of 46.53 years ±10.01 S.D in Group A and 46.19 ±9.58 S.D in Group B. In Group A 98.6% of patients were male, and 1.4% were females while in Group B 100% of patients were male. It was found that mean pain in Group A was 4.88 ±0.887 and 5.29± 0.777 at 6 hours and 24 hours respectively. Mean pain in group B was 3.43 ±0.962 and 4.11±0.703 at 6 hours and 24 hours respectively. Moreover, mean pain in Group B was significantly less than mean pain in Group A both at 6 hours and 24 hours intervals with a p-value < 0.001. The early postoperative complications were not significantly different in both groups. Conclusion: In TAPP repair, suture fixation of mesh is less painful than tack fixation. However, there is no significant difference in the rate of other early postoperative outcomes like seroma, hematoma, urinary retention, and neuralgia. Further multicentric studies with a longer duration of follow-up are needed to validate our results.

When hernia mesh erodes into the bowel

Incisional hernia repair surgery is commonly performed by using a synthetic mesh; due to its low complication rate. This article describes the management of a patient with mesh erosion into the small bowel, a rare complication of mesh-based ventral hernia repair. Fatigue secondary to iron-deficiency anemia and disfigurement from his hernia were his only symptoms. The patient was conservatively managed for several years due to the risks associated with restorative surgery. Eventually, due to deterioration of his health as well as advances in the techniques of abdominal wall reconstruction, the patient underwent surgery. The patient made excellent recovery. The complications associated with the synthetic mesh are likely to be very underreported. This article discusses the factors leading to mesh erosion, including mesh type, fixation methods, mesh migration, and mesh position, and it emphasizes the importance of reporting and following up hernia patients to advance the science behind mesh technology and surgical techniques surrounding ventral hernia repair.

A biomechanical analysis of different meshes for reconstructions of the pelvic floor in the porcine model

PurposeMany different surgical approaches have been established for the repair of a pelvic organ prolapse. Especially in laparoscopic surgery, it is important to generate easy surgical techniques with similar stability. This study shall simplify the choice of mesh by evaluating three polypropylene meshes regarding their biomechanical properties.MethodsBiomechanical testing was performed in the porcine model. The meshes are fixated on porcine fresh cadaver cervices after subtotal hysterectomy. The apical part of the mesh is fixated with parallel screw clamps at the testing frame. Forty-one trials were performed overall, subdivided into four subgroups. The groups differ in mesh type and fixation method. Maximum load, displacement at failure and stiffness parameters were evaluated with an Instron 5565® test frame.ResultsSERATEX® E11 PA (E11) showed the highest values for maximum load (199 ± 29N), failure displacement (71 ± 12 mm) and stiffness (3.93 ± 0.59 N/mm). There was no significant difference in all three evaluated parameters between SERATEX® B3 PA (B3) and SERATEX® SlimSling® with bilateral fixation (SSB). SERATEX® SlimSling® with unilateral fixation (SSU) had the lowest stiffness (0.91 ± 0.19 N/mm) and maximum load (30 ± 2 N) but no significant difference in displacement at failure.ConclusionAll meshes achieved a good tensile strength, but the results of maximum load show that the E11 is superior to the other meshes. Through a bilateral fixation of SERATEX® SlimSling®, a simple operating method is generated without a loss of stability.

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh.

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been associated with lesser hernia recurrence when compared to the primary suture repair. The type of mesh that is most appropriate is still debatable. Synthetic and biosynthetic materials have been studied in the literature. It is well documented that a synthetic mesh is associated with esophageal erosion and migration into the stomach. Though there are limited long-term data on biosynthetic mesh, the short-term results are excellent and promising. This paper illustrates how a biosynthetic prosthesis can be safely used with fibrin glue fixation and anterior Dor fundoplication to repair any para-esophageal defect. The absorbable biosynthetic mesh has been shown to produce good long-term patient satisfaction outcomes and low recurrence rates compared to conventional methods including repair with synthetic mesh. This technique also avoids the risk of esophageal erosion whilst strengthening the repair. Tacks that are still widely used to secure the mesh can be abandoned due to the associated risk of developing cardiac tamponade, or other disastrous consequences. This repair method, also, highlights how the prosthesis can be fashioned into a V-shape and easily placed in an onlay fashion behind the esophagus. The protocol demonstrates an alternative and safer method for mesh fixation using fibrin glue.

Mesh fixation with fibrin glue versus tacker in laparoscopic totally extraperitoneal inguinal hernia repair.

The advent of mesh was a breakthrough in the field of hernia surgery. Mechanical methods of mesh fixation are hypothesized to cause more tissue trauma than nonmechanical methods. The present study was conducted to study the outcomes of mesh fixation using fibrin glue, a nonmechanical method versus tackers in totally extraperitoneal repair (TEP) of unilateral inguinal hernia. A randomized controlled single blinded study was conducted in India from June 2017 to March 2019. Patients diagnosed with unilateral uncomplicated inguinal hernia with a hernial sac of size not more than 5cm were invited to participate in the study. Sample size was 60 patients randomized into groups just before mesh fixation. In group A mesh was fixed using tackers while in group B mesh was fixed using fibrin glue. Patients were followed-up prospectively for 3 months. There was no statistical difference between the two groups with respect to operating time. Average hospital stay and pain scores at all follow-ups were better for fibrin glue group. There was no difference in the incidence of postoperative urinary retention, seroma formation and hematoma formation between the two groups. Patients of fibrin glue group had early restart of daily activities at 15 days follow-up when compared to tacker group. Fibrin glue fixation technique should be advocated over tackers for mesh fixation in TEP considering the better outcomes and cost-effectiveness of the technique.

Outcome of percutaneous mesh fixation in transabdominal preperitoneal groin hernia repair

Background One of the commonly performed surgical procedures in general surgical practice is groin hernia repair. Different procedures have been prescribed for hernioplasty either by open or laparoscopic approaches. Tension-free hernioplasty and obliteration of myopectineal orifices necessitate mesh insertion with different methods for its fixation. Chronic groin pain post hernioplasty (either open or laparoscopic) has been considered multifactorial and most of it has been attributed to the method of mesh fixation. Aim This study aims to evaluate the outcome of temporary percutaneous mesh fixation in transabdominal preperitoneal repair (TAPP) using a fascial closure device or straight needle suture. Patients and methods This prospective study was carried out in the Department of General Surgery Al-Hussein Hospital, Al-Azhar University, Cairo, from October 2016 to December 2017, during which 30 patients were subjected to laparoscopic TAPP hernioplasty with percutaneous mesh fixation and followed up for 1 year. A full preoperative assessment was carried out on all patients. TAPP hernioplasty with percutaneous mesh fixation was performed for all patients; postoperative follow-up was performed for detection of early and late postoperative complications. All cases were followed up for 1 year to detect late complications such as chronic pain and recurrence. Results In this study, the mean age of the patients was 39.2 years. The operative time ranged from 50 to 90 min. All patients underwent uneventful TAPP repair for groin hernia; only one patient had port site bleeding, which was properly controlled during surgery. All patients were discharged on the second postoperative day with a mean hospital stay of 1 day and allowed to resume daily activities at mean 7.5 days postoperatively. Pseudohernia developed in 10% of patients without true recurrence. Only one patient developed recurrence 6 months postoperatively. One year postoperatively, none of the patients had persistent pain and there was no other recurrence. Conclusion Temporary percutaneous mesh fixation in TAPP hernioplasty either by fascial closure device or by straight needle suture is sufficient, effective in mesh fixation and reasonable in terms of cost, enabling better availability to all patients, and yielding nearly the same recurrence rate as ordinary TAPP without permanent groin pain.

Laparoscopic fixation of biological mesh at hiatus with glue and suture during hiatal hernia repair

BackgroundLaparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs.MethodsA retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence.ResultsThirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy.ConclusionsBiological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.