Comparing 30-day outcomes between different mesh fixation techniques in minimally invasive 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 techniques for laparoscopic inguinal hernia repair in adults

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd008954.pub2 ◽

2017 ◽

Cited By ~ 2

Author(s):

Ajay Gupta ◽

Fayyaz Mazari ◽

Nehemiah Samuel ◽

Srinivasan Balchandra

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Fixation ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Fixation Techniques

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Initial experience using a handheld fully articulating software-driven laparoscopic needle driver in TAPP inguinal hernia repair

Surgical Endoscopy ◽

10.1007/s00464-021-08446-6 ◽

2021 ◽

Author(s):

Victoria Needham ◽

Diego Camacho ◽

Flavio Malcher

Keyword(s):

Inguinal Hernia ◽

Minimally Invasive ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Fixation ◽

Initial Experience ◽

Needle Driver ◽

Peritoneal Closure ◽

Standard Laparoscopy ◽

Suture Closure

Abstract Background The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a widely performed minimally invasive operation, but can present considerable ergonomic challenges for the surgeon. Our objective was to determine if a novel handheld software-driven laparoscopic articulating needle driver can mitigate these difficulties. Methods The video recordings of a consecutive series of TAPP cases by a single surgeon using the articulating device were compared with a series of cases using straight-stick laparoscopy. Two critical steps of the procedure were analyzed for time: mesh fixation and peritoneal suture closure. These steps were then compared before and after 10 initial consecutive cases to analyze whether the surgeon demonstrated improvement. A cost analysis was also performed between the two techniques. Results For mesh fixation, the surgeon averaged 227 s using tacker devices, compared with 462.4 s using the novel laparoscopic device (p = 0.06). For the peritoneal closure component of the operation, the surgeon improved the time per suture pass during closure from 60.61 s during the first 10 cases to 38.84 s after the first 10 cases (p = 0.0004), which was comparable to the time per stitch for standard laparoscopy (34.8 s vs 34.84 s, p = 0.997). Left-sided inguinal hernia repairs using the articulating device demonstrated a significantly longer time per stitch during peritoneal closure compared to the right side after first 10 cases (left: 40.62 s; right: 27.91, p = 0.005). Our direct cost analysis demonstrated that suture closure of the peritoneum using the articulating device was more cost-effective than tack fixation. Conclusions After only a 10 case initial experience, a laparoscopic hand-held articulating needle driver is comparable to standard laparoscopy to complete suture mesh fixation and peritoneal closure for TAPP inguinal hernia repair. Further, the feasibility of suture mesh fixation minimizes the need for costly tacker devices. This instrument appears to be a promising tool in this largely minimally invasive era of hernia repair.

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Mesh fixation techniques for laparoscopic inguinal hernia repair in adults

10.1002/14651858.cd008954 ◽

2011 ◽

Cited By ~ 1

Author(s):

Karen Dickinson ◽

Kirsty McCormack ◽

Neil Scott ◽

Adeshina Fawole ◽

Clive White ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Mesh Fixation ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Fixation Techniques

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Mesh fixation technique for inguinal hernia repair: protocol for an umbrella review with integrated and updated network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-031742 ◽

2019 ◽

Vol 9 (10) ◽

pp. e031742

Author(s):

Suphakarn Techapongsatorn ◽

Amarit Tansawet ◽

Wisit Kasetsermwiriya ◽

Oraluck Pattanaprateep ◽

Ammarin Thakkinstian

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Meta Analysis ◽

Mesh Fixation ◽

Laparoscopic Inguinal Hernia Repair ◽

Umbrella Review ◽

Hernia Mesh ◽

Fixation Techniques ◽

Meta Analyses

IntroductionInguinal hernia mesh repair is the standard care for symptomatic inguinal hernia. Mesh fixation is used to keep mesh in place for which various mesh fixation techniques have been used in open and laparoscopic inguinal hernia repair, but their effectiveness has remained inconclusive. Therefore, we developed a protocol for an umbrella review in order to summarise the evidences with integrate and update data of different mesh fixation techniques in both open and laparoscopic inguinal hernia repair.Methods and analysisPrevious systematic reviews and meta-analyses will be identified from Medline, Scopus, Cochrane Databases, EMBASE, Database of Abstracts of Reviews of Effects, PROSPERO Register, CINAHL, JBISRIS, EPPI-Centre, Wiley Online Library and Science Direct database. Two reviewers will independently determine studies for eligibility. Disagreement will be solved by consensus and arbitrated by the third reviewer. Data extraction will also be performed by two independent reviewers. For umbrella review, a descriptive analysis will be applied to describe evidence of mesh fixation effectiveness. Overlapping studies and excess significance test will be performed to assess whether previous evidences are bias. In addition, individual studies from meta-analysis and additional published studies will be pooled using network meta-analyses. We will use I2statistic and Cochran’s Q test to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as overall strength of the evidence.Ethics and disseminationThis protocol has been registered with PROSPERO and approved with Institutional Review Board, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand (COA 167/2018). The results will be published in peer-reviewed journal.PROSPERO registration numberCRD42018111773

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