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Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study

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Abstract

Purpose

Mesh fixation is essential in laparoscopic total extraperitoneal (TEP) repair of inguinal hernia; however, fixation sometimes causes post-operative pain. This study investigated a novel method of laparoscopic TEP repair without mesh fixation.

Methods

This study reviewed data from about two-hundred and forty-one laparoscopic TEP repairs on 219 patients, which were performed between December 2004 and October 2005.

Results

There were no statistically significant differences in the recurrence rate, seroma formation, and hospital stay. However, the mean operation time was shorter in the internal plug mesh group than the fixation group (p = 0.009), and post-operative pain only occurred in 4 cases in the internal plug mesh group in comparison to 29 cases in the mesh fixation group (p = 0.014).

Conclusions

An internal plug mesh without fixation might reduce post-operative pain after laparoscopic TEP repair of an inguinal hernia. Internal plug mesh without fixation may be an alternative method in laparoscopic TEP repair, especially for those involving indirect hernias.

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References

  1. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR. Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg. 2003;90(12):1479–92.

    Article  PubMed  CAS  Google Scholar 

  2. Kumar S, Wilson RG, Nixon SJ, Macintyre IM. Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg. 2002;89(11):1476–9.

    Article  PubMed  CAS  Google Scholar 

  3. Inaba T, Okinaga K, Fukushima R, Ikeda Y, Yamazaki E, Koide T, Horikawa M, Inoue T, Ogawa E. Chronicpain and discomfort after inguinal hernia repair. Surg Today 2012;Mar 1.

  4. Taylor C, Wilson T. Long-term results of laparoscopic totally extraperitoneal inguinal herniorrhaphy. ANZ J Surg. 2005;75:637–9.

    Article  PubMed  Google Scholar 

  5. Lau H, Patil NG, Yuen WK, Lee F. Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc. 2003;17(10):1620–3.

    Article  PubMed  CAS  Google Scholar 

  6. Lowham AS, Filipi CJ, Fitzgibbons RJ Jr, Stoppa R, Wantz GE, Felix EL, Crafton WB. Mechanism of hernia recurrence after preperitoneal mesh repair: traditional and laparoscopic. Ann Surg. 1997;225(4):422–31.

    Article  PubMed  CAS  Google Scholar 

  7. Tetik C, Arregui ME, Dulucq JL, Fitzgibbons RJ, Franklin ME, McKernan JB, et al. Complications and recurrences associated with laparoscopic repair of groin hernias: a multi-institutional retrospective analysis. Surg Endosc. 1994;8:1316–23.

    Article  PubMed  CAS  Google Scholar 

  8. Felix E, Scott S, Crafton B, Geis P, Duncan T, Sewell R, et al. Causes of recurrence after laparoscopic hernioplasty: a multicenter study. Surg Endosc. 1998;12:226–31.

    Article  PubMed  CAS  Google Scholar 

  9. Phillips EH, Rosenthal R, Fallas M, Carroll B, Arregui M, Corbitt J, et al. Reasons for recurrence following laparoscopic hernioplasty. Surg Endosc. 1995;9:140–5.

    PubMed  CAS  Google Scholar 

  10. Wong J, Anvari M. Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers. Surg Laparosc Endosc Percutan Tech. 2001;11(2):148–51.

    PubMed  CAS  Google Scholar 

  11. Lau H. Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg. 2005;242(5):670–5.

    Article  PubMed  Google Scholar 

  12. Golash V. Technique of suturing the mesh in laparoscopic total extra peritoneal (TEP) repair of inguinal hernia. Surgeon. 2004;2(5):264–72.

    Article  PubMed  CAS  Google Scholar 

  13. Jourdan IC, Bailey ME. Initial experience with the use of N-butyl 2-cyanoacrylate glue for the fixation of polypropylene mesh in laparoscopic hernia repair. Surg Laparosc Endosc. 1998;8(4):291–3.

    Article  PubMed  CAS  Google Scholar 

  14. Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S. Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomized clinical trial. Surg Endosc. 2008;22:757–62.

    Article  PubMed  Google Scholar 

  15. Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic totally extraperitoneal approach with open mesh repair in inguinal hernia. Surg Laparosc Endosc Percutan Tech. 2003;13:191–5.

    Article  PubMed  Google Scholar 

  16. Andersson B, Hallen M, Leveau P, Bergenfelz A, Westerdahl J. Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial. Surgery. 2003;133:464–72.

    Article  PubMed  Google Scholar 

  17. Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B, Anderberg B. Tension free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein, a prospective randomized controlled trial. Ann Surg. 2003;237:142–7.

    Article  PubMed  Google Scholar 

  18. Kraus MA. Nerve injury during laparoscopic inguinal hernia repair. Surg Laparosc Endosc. 1993;3:342–5.

    PubMed  CAS  Google Scholar 

  19. Chevallier JM, Wind P, Lassau JP. Damage to the inguino-femoral nerves in the treatment of hernias. An anatomical hazard of traditional and laparoscopic techniques. Ann Chir. 1996;50:767–75.

    PubMed  CAS  Google Scholar 

  20. Dion YM, Laplante R, Charara J, Marois M. The influence of the number of endoclips and of mesh incorporation on the strength of an experimental hernia patch repair. Surg Endosc. 1994;8(11):1324–8.

    Article  PubMed  CAS  Google Scholar 

  21. Ferzli GS, Frezza EE, Pecoraro AM Jr, Ahern KD. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg. 1999;188(5):461–5.

    Article  PubMed  CAS  Google Scholar 

  22. Khajanchee YS, Urbach DR, Swanstrom LL, Hansen PD. Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc. 2001;15(10):1102–7.

    Article  PubMed  CAS  Google Scholar 

  23. Beattie GC, Kumar S, Nixon SJ. Laparoscopic total extraperitoneal hernia repair: mesh fixation is unnecessary. J Laparoendosc Adv Surg Tech. 2000;10(2):71–3.

    Article  CAS  Google Scholar 

  24. Spitz JD, Arregui ME. Sutureless laparoscopic extraperitoneal herniorrhaphy using reusable instruments: two hundred three repairs without recurrence. Surg Laparosc Endosc Percutan Tech. 2000;10(1):24–9.

    PubMed  CAS  Google Scholar 

  25. Ellner S, Daoud I, Gulleth Y. Over five hundred laparoscopic totally extraperitoneal hernia repairs using mesh without fixation. Oral presentation (S061) at Society of American Gastrointestinal and Endoscopic Surgeons annual meeting Dallas, Texas USA. 2006;April 26–29.

  26. Moreno-Egea A, Torralba Martinez JA, Morales Cuenca G, Aguayo Albasini JL. Randomized clinical trial of fixation vs nonfixation of mesh in total extraperitoneal inguinal hernioplasty. Arch Surg. 2004;139(12):1376–9.

    Article  PubMed  Google Scholar 

  27. Tamme C, Scheidbach H, Hampe C, Schneider C, Kockerling F. Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc. 2003;2:190–5.

    Article  Google Scholar 

  28. Dalenbäck J, Andersson C, Anesten B, Björck S, Eklund S, Magnusson O, et al. Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. The BOOP study: bi-layer and connector, on-lay, and on-lay with plug for inguinal hernia repair. Hernia. 2009;13(2):121–9.

    Article  PubMed  Google Scholar 

  29. Zhao G, Gao P, Ma B, Tian J, Yang K. Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg. 2009;250(1):35–42.

    Article  PubMed  Google Scholar 

  30. Negro P, D’Amore L, Gossetti F. Lichtenstein’s operation, mesh plug, or prolene hernia system repair for groin hernia: which is better? Ann Surg. 2010;252(1):199. (author reply 199–200).

    Article  PubMed  Google Scholar 

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Conflict of interest

Dr. Yoon Young Choi, Dr. Zisun Kim and Dr. Kyung Yul Hur have no conflict of interest.

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Correspondence to Kyung Yul Hur.

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Choi, Y.Y., Kim, Z. & Hur, K.Y. Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study. Surg Today 43, 603–607 (2013). https://doi.org/10.1007/s00595-012-0276-8

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  • DOI: https://doi.org/10.1007/s00595-012-0276-8

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