Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair

Abstract Purpose Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques. Methods We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool. Results We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence. Conclusion Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect.

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Mesh Fixation versus Non Fixation in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair

QJM ◽

10.1093/qjmed/hcaa050.027 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A B Lachin ◽

A A Abdrabbu ◽

A A F Darwish ◽

M M K Ali

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Mesh Fixation ◽

Operation Time ◽

Fixation Group ◽

Transabdominal Preperitoneal ◽

Transabdominal Preperitoneal Inguinal Hernia

Abstract Background inguinal hernia repair is the most common procedure in general and visceral surgery worldwide. Several studies have shown that laparoscopic repair offers the advantage of minimally invasive surgery to the patient. The mesh can be placed without fixation or can be fixed into place with tuckers. Aim of the Work this study aimed to compare mesh fixation versus non-fixation in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia, as regards the operation time, hospitalization, postoperative complication, recurrence and chronic pain. Patients and Methods sixty adult males with inguinal hernia were repaired with laparoscopic transabdominal preperitoneal inguinal hernia repair, divided into; mesh fixation group (n = 35) versus non-fixation group (n = 25), and certain parameters were assessed during the operative, postoperative and follow-up periods. Results mean operation time and mean hospital stay time were significantly higher in mesh fixation group than non-fixation group. VAS scores 2days, 3months, and 6months postoperative were less for non-fixation group. Non-significant difference was found between both groups regarding intraoperative injury, hernia recurrence, wound seroma, mesh infection, chronic pain, return to physical activity. Conclusion TAPP inguinal hernioplasty without mesh fixation does not increase recurrence rate, but reduces operative duration, hospital stay duration and decreases the incidence of postoperative pain.

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