FIXATION VS NON-FIXATION OF MESH IN INGUINAL HERNIA REPAIR USING THE TEP (TOTALLY EXTRAPERITONEAL) TECHNIQUE

Abstract

Background: Laparoscopic inguinal hernia repair is associated with two major complications including chronic groin pain and recurrence. Laparoscopic hernia repair utilizes mesh fixing using trackers which can increase chronic groin pain due to nerve injuries which led to the use of nonfixation of mesh. However, it does not decrease the recurrence. Aim: The present study aimed to assess the outcomes of fixation versus non-fixation of mesh in Inguinal hernia repair using the TEP (totally extraperitoneal) technique.
Methods: The present study assessed 61 subjects retrospectively where mesh fixation was done in 22 subjects and non-fixation in 39 subjects and had a minimum of 1 year follow-up. In all subjects, chronic groin pain and recurrence were assessed along with cost, days needed for return to routine, hospital stay duration, urinary retention incidence, immediate post-operative pain, and operative time.
Results: For unilateral inguinal hernia repair with and without mesh fixation, the operative time was 41.6±11.6 and 35.7±9.9 min (p=0.02), whereas, for bilateral inguinal hernia repair, the operative time was 66.4±15.4 and 55.1±14.4 (p=0.01) mins respectively. In the two groups, the mean pain score was 3.46±1.4 and 3.03±1.2 respectively with p=0.03. Incidence of chronic groin pain was 3.33% (n=1) and 3.22% (n=1) (p=1.00) at mean follow-up of 18.9±6.4 and 33.4±17.2 months respectively.
Conclusions: The present study concludes that increased recurrence is not associated with nonfixation of mesh in laparoscopic inguinal hernia repair. However, non-fixation of mesh is not associated with decreased chronic groin pain incidence. The advantages of non-mesh fixation include decreased treatment cost, lesser postoperative pain, and decreased intraoperative time.