Skip to main content
SpringerLink
Log in

Long-term follow-up of laparoscopic total extraperitoneal (TEP) repair in inguinal hernia without mesh fixation

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

From the current evidence, non-fixation of the mesh (NMF) in laparoscopic total extraperitoneal (TEP) repair appears to be a safe alternative for inguinal hernia patients in the short term. This study aims to demonstrate that NMF is as effective in the long term by following up a large number of patients with a mean follow-up of 6 years. The primary outcomes are chronic pain and recurrence rate.

Methods

A thorough review of medical records was conducted from a prospectively maintained database of 538 patients who underwent a laparoscopic TEP inguinal hernia repair by a single surgeon working in Sydney from the year 2005 to 2010. Patient demographics, perioperative outcomes, and postoperative complications were extracted from this database. All these patients were then interviewed using a modified questionnaire based on Franneby et al. [10].

Result

538 patients had TEP repair between 2005 and 2010. Out of this 11 were excluded as tacks were used for fixation of mesh. Out of the 649 repairs done on 527 patients during this period, 463 hernia repairs in 387 patients could be followed up with a mean follow-up of 6 years and 4 months. The mean age of patients was 63 years. Overall, there were seven (1.5%) recurrences, and the incidence of chronic pain was 1%, however 2.9% patients in total complained of pain.

Conclusion

This is the only study in literature having a long-term follow-up of more than 5 years for the patients having inguinal hernia repair by TEP technique without mesh fixation. It demonstrates that fixation of mesh with tacks or glue is unnecessary for TEP repair of inguinal hernia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Teng YJ, Pan SM, Liu YL, Yang KH, Zhang YC, Tian JH, Han JX (2011) A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair. Surg Endosc 25:2849–2858. doi:10.1007/s00464-011-1668-3

    Article  PubMed  Google Scholar 

  2. Memon MA, Cooper NJ, Memon B, Memon MI, Abrams KR (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90:1479–1492. doi:10.1002/bjs.4301

    Article  CAS  PubMed  Google Scholar 

  3. Wong J, Anvari M (2001) Treatment of inguinodynia after laparoscopic herniorrhaphy: a combined laparoscopic and fluoroscopic approach to the removal of helical tackers. Surg Laparosc Endosc Per Tech 11:148–151

    CAS  Google Scholar 

  4. Poobalan AS, Bruce J, Smith WCS, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54

    Article  PubMed  Google Scholar 

  5. Boldo E, Armelles A, Perez de Lucia G, Martin F, Aracil JP, Miralles JM, Martinez D, Escrig J (2008) Pain after laparascopic bilateral hernioplasty: early results of a prospective randomized double-blind study comparing fibrin versus staples. Surg Endosc 22:1206–1209. doi:10.1007/s00464-007-9587-z

    Article  CAS  PubMed  Google Scholar 

  6. Olmi S, Scaini A, Erba L, Guaglio M, Croce E (2007) Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery 142:40–46. doi:10.1016/j.surg.2007.02.013

    Article  PubMed  Google Scholar 

  7. Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillace G, Longoni M (2007) Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg 245:222–231. doi:10.1097/01.sla.0000245832.59478.c6

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sajid MS, Ladwa N, Kalra L, Hutson K, Sains P, Baig MK (2012) A meta-analysis examining the use of tacker. Int J Surg 10:224–231. doi:10.1016/j.ijsu.2012.03.001

    Article  CAS  PubMed  Google Scholar 

  9. Novik B, Hagedorn S, Mork U-B, Dahlin K, Skullman S, Dalenback J (2006) Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period. Surg Endosc 20:462–467. doi:10.1007/s00464-005-0391-3

    Article  CAS  PubMed  Google Scholar 

  10. Fränneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyrén O, Sandblom G (2008) Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg 95:488–493. doi:10.1002/bjs.6014

    Article  PubMed  Google Scholar 

  11. Tam K-W, Liang H-H, Chai C-Y (2010) Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg 34:3065–3074. doi:10.1007/s00268-010-0760-5

    Article  PubMed  Google Scholar 

  12. Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S (2008) Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial. Surg Endosc 22:757–762. doi:10.1007/s00464-007-9510-7

    Article  PubMed  Google Scholar 

  13. Staarink M, Veen RN, Hop WC, Weidema WF (2008) A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 22:1803–1806. doi:10.1007/s00464-008-9917-9

    Article  CAS  PubMed  Google Scholar 

  14. Messenger DE, Aroori S, Vipond MN (2010) Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients. Ann R Coll Surg Engl. doi:10.1308/003588410X12628812458455

    PubMed  PubMed Central  Google Scholar 

  15. Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249:33–38. doi:10.1097/SLA.0b013e31819255d0

    Article  PubMed  Google Scholar 

  16. Sajid MS, Ladwa N, Kalra L, McFall M, Baig MK, Sains P (2013) A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 206:103–111. doi:10.1016/j.amjsurg.2012.09.003

    Article  PubMed  Google Scholar 

  17. Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty. Ann Surg 242:670–675. doi:10.1097/01.sla.0000186440.02977.de

    Article  PubMed  PubMed Central  Google Scholar 

  18. Khaleal F, Berney C (2011) The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a single surgeon’s experience. ANZ J Surg 81:154–158. doi:10.1111/j.1445-2197.2010.05438.x

    Article  PubMed  Google Scholar 

  19. Birk D, Hess S, Garcia-Pardo C (2013) Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGrip™ mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months. Hernia 17:313–320. doi:10.1007/s10029-013-1053-3

    Article  CAS  PubMed  Google Scholar 

  20. Ferzli GS, Frezza EE, Pecoraro AM Jr (1999) Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg 188(5):461–465

    Article  CAS  PubMed  Google Scholar 

  21. Khajanchee YS, Urbach DR, Swanstrom LL, Hansen PD (2001) Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc 15:1102–1107. doi:10.1007/s004640080088

    Article  CAS  PubMed  Google Scholar 

  22. Messaris E, Nicastri G, Dudrick SJ (2010) Total extraperitoneal laparoscopic inguinal hernia repair without mesh fixation: prospective study with 1-year follow-up results. Arch Surg 145(4):334–338

    Article  PubMed  Google Scholar 

  23. Pankaj Garg MI (2009) Laparoscopic total extraperitoneal repair in femoral hernia without fixation of the mesh. J Soc Laparoendosc Surg 13:597–600. doi:10.4293/108680809X12589999537995

    Article  Google Scholar 

  24. Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27:2373–2382. doi:10.1007/s00464-013-2797-7

    Article  PubMed  Google Scholar 

  25. Eklund A, Montgomery A, Bergkvist L (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97(4):600–608. doi:10.1002/bjs.6904

    Article  CAS  PubMed  Google Scholar 

  26. Koch CA, Greenlee SM, Larson DR, Harrington JR, Farley DR (2006) Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. J Soc Laparoendosc Surg 10(4):457–460

    Google Scholar 

  27. Phillips EH, Arregui M, Carroll BJ, Corbitt J, Crafton WB, Fallas MJ, Filipi C, Fitzgibbons RJ, Franklin MJ, McKernan B (1995) Incidence of complications following laparoscopic hernioplasty. Surg Endosc 9:16–21

    CAS  PubMed  Google Scholar 

  28. Liem MS, van Duyn EB, van der Graaf Y, van Vroonhoven TJ, Coala Trial Group (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237(1):136–141

    Article  PubMed  PubMed Central  Google Scholar 

  29. Choy C, Shapiro K, Patel S, Graham A, Ferzli G (2004) Investigating a possible cause of mesh migration during totally extraperitoneal (TEP) repair. Surg Endosc 18:523–525. doi:10.1007/s00464-003-8183-0

    Article  CAS  PubMed  Google Scholar 

  30. Ali SM, Zendejas B, Yadav S, Hernandez-Irizarry RC, Lohse CM, Farley DR (2013) Predictors of chronic groin discomfort after laparoscopic totally extraperitoneal inguinal hernia repair. J Am Coll Surg 217:72–78. doi:10.1016/j.jamcollsurg.2013.03.005 (discussion 78–80)

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgery and Anaesthetics, Hornsby Ku-Ring-Gai Hospital, Palmerston Road, Hornsby, NSW, 2077, Australia

    S. Golani & P. Middleton

Authors
  1. S. Golani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Middleton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Golani.

Ethics declarations

Conflict of interest

Dr SG and Dr PM have no competing interests or financial ties to disclose.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Statement of human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was indeed obtained from all individual participant included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Golani, S., Middleton, P. Long-term follow-up of laparoscopic total extraperitoneal (TEP) repair in inguinal hernia without mesh fixation. Hernia 21, 37–43 (2017). https://doi.org/10.1007/s10029-016-1558-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-016-1558-7

Keywords

Search

Navigation