Comparative Study of Mesh Fixation and Non-Fixation in Transabdominal Pre-Peritoneal Inguinal Hernia Repair

Abstract

Background: The fixation of the mesh remains unresolved in transabdominal preperitoneal inguinal hernia (TAPP).  Surgeons had previously fixed the mesh using laparoscopic stapling devices, tacks, suturing techniques and recently adhesives. Fixation of mesh was done to prevent migration of mesh resulting in recurrence but many studies showed non fixation of mesh was not associated with any increased risk of hernia recurrence. Fixing the mesh not only increases the cost and duration of procedure but also could cause complications like post-operative pain.  Hence, this study was an attempt to resolve this controversy surrounding recurrence with mesh non fixation.

Methods: A sample of 90 patients to undergo TAPP inguinal hernia repair as an elective surgery were taken. 45 patients underwent fixation of polypropylene mesh (by tackers or sutures) as group A and the remaining 45 with non-fixation of mesh in group B. The outcome of surgery in terms of post-operative pain,mesh migration and recurrence was recorded.

Results: Pain intensity had been assessed by a visual analogue scale - VAS (0 (no pain) to 10 (worst pain). For the comparison of VAS pain after 24 hours, the minimum value of 2.00 and maximum value of 4.00 with Mean and SD value of 3.02 ± 0.39 were reported in Group A (n=45). The minimum value of 4.00 and maximum value of 6.00 with Mean and SD value of 5.02 ± 0.34 were reported in Group B (n=45). The total variable for VAS pain after 24 hours, variable between the two groups (n=90) with the minimum value of 2.00 and maximum value of 6.00 with Mean and SD value of 4.02 ± 1.07 were reported. Two (4.4%) cases from group A and 2 (4.4%) cases from group B with a total of 4 (4.4%) cases tested positive for the recurrence of 6th Month follow up.

Conclusion: Mesh fixation involves more operative time, more so with suture fixation. It involves more postoperative pain, both with tacker or suture fixation. Non-fixation during Transabdominal preperitoneal repair of inguinal hernias is as safe as mesh fixation with certain advantages. It does not lead to increased recurrence though it does not decrease the incidence of chronic groin pain. Collateral advantage would be decreased operative times, lesser post-operative pain, and decreased costs.