LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) INDIRECT INGUINAL HERNIA REPAIR WITHOUT MESH FIXATION. IS MESH FIXATION NECESSARY?

Dr Jignesh Shah, Dr Ruchir Jhaveri, Dr Kartik Gorasiya

Abstract


Introduction: Reduction of chronic groin pain in hernia surgery has become one of the major points of interest in research in the field. Of course, no new approach to reduce CGP should be at the cost of a higher recurrence rate. Omission of mesh fixation has been tried to reduce CGP. This is a retrospective study to ascertain the long-term results of this technique in terms of recurrence and chronic groin pain.

Methods: 79 cases of indirect inguinal hernia operated by laparoscopic transabdominal preperitoneal approach were included. Standard surgical technique was applied, wherein no form of mesh fixation was used. All cases were retrospectively evaluated for recurrence, other complications and CGP. The mean follow-up duration was 3.3 years, (range: 1-7 years)

Results: Of the 79 cases, none developed recurrence, other complications or moderate/severe CGP. 2 cases (2.5%) had mild CGP (VAS 2 and 3).

Discussion: Application of tacker or suture for mesh fixation plays a central role in many of the causes of CGP. Hence it can be inferred that chance of CGP is likely to decrease if mesh fixation is avoided. The concern of recurrence with this approach can be negated by the findings of this study and others, which suggest that recurrence rate does not increase if mesh is not fixed in laparoscopic TAPP done for indirect inguinal hernia. By Avoiding the use of a tacker, a significant reduction in cost of the materials occurs.

Conclusion: Based on our findings in this study, we can conclude that avoidance of mesh fixation in laparoscopic transabdominal preperitoneal hernia repair of indirect inguinal hernia does not increase the risk of recurrence, and may reduce chronic groin pain, and clearly reduces cost of the materials needed for the surgery. Hence, omission of mesh fixation can be safely tried in TAPP done for indirect inguinal hernia without an increase in the risk of recurrence.


Keywords


Inguinal hernia, laparoscopic, transabdominal pre-peritoneal, repair, mesh xation, non-xation, tacker, chronic groin pain, recurrence.

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