Surgical Endoscopy

, Volume 26, Issue 4, pp 1079–1085 | Cite as

Objective hypoesthesia and pain after transabdominal preperitoneal hernioplasty: a prospective, randomized study comparing tissue adhesive versus spiral tacks

  • Lukas BrüggerEmail author
  • Martina Bloesch
  • Ramin Ipaktchi
  • Anita Kurmann
  • Daniel Candinas
  • Guido Beldi



Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed objectively. We objectively investigated hypoesthesia and chronic pain after transabdominal preperitoneal inguinal hernia repair (TAPP) with titanium spiral tacks (STs) compared with tissue adhesive (TA) for mesh fixation.


Mesh fixation in 80 TAPP procedures was randomized to fixation with ST (n = 40) or TA (n = 40). The outcome parameters included hypoesthesia assessed with von Frey monofilaments, early postoperative and chronic pain with the visual analog scale (VAS), morbidity (surgical-site infection, hematoma/seroma, relapse of hernia, trocar hernia), and recovery time to normal activity.


Median (range) follow-up was 38 (13–56) months. Demographic and baseline parameters were similar in the two groups. Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group (6 weeks: 32 vs. 6%; 6 months: 38 vs. 14%; 12 months: 34 vs. 13%; 13–56 months: 32 vs. 4%). Mean hypoesthesia scores over all time points were significantly higher in the ST group. The percentages of regions with hypoesthesia (abdominal, inguinal, or genitofemoral) following all procedures were higher in the ST group after 6 weeks (14 vs. 2%), 6 months (15 vs. 5%), and 13–56 months (22 vs. 4%). The intensity of pain decreased significantly in both groups over time.


Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling.


Inguinal hernia Laparoscopy Mesh Pain Hypoesthesia 



We thank Brigitte Wanner for meticulous data collection and Dr. Stephan Vorburger for advice with statistical analysis. This study was supported by a grant from Anklin AG, 4102 Binningen, Switzerland.


Authors Lukas Brügger, Martina Boesch, Ramin Ipaktchi, Anita Kurmann, Daniel Candinas, and Guido Beldi have no conflicts of interest or financial ties to disclose.


  1. 1.
    EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235:322–332CrossRefGoogle Scholar
  2. 2.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev CD001785Google Scholar
  3. 3.
    Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Fugger R, Scheyer M (2008) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12:385–389PubMedCrossRefGoogle Scholar
  4. 4.
    Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs. Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:188–199PubMedCrossRefGoogle Scholar
  5. 5.
    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 90:1479–1492PubMedCrossRefGoogle Scholar
  6. 6.
    Butters M, Redecke J, Koninger J (2007) Long-term results of a randomized clinical trial of shouldice, lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 94:562–565PubMedCrossRefGoogle Scholar
  7. 7.
    Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C (2010) Long-term cost-minimization analysis comparing laparoscopic with open (lichtenstein) inguinal hernia repair. Br J Surg 97:765–771PubMedCrossRefGoogle Scholar
  8. 8.
    Eklund A, Montgomery A, Bergkvist L, Rudberg C (2010) Chronic pain 5 years after randomized comparison of laparoscopic and lichtenstein inguinal hernia repair. Br J Surg 97:600–608PubMedCrossRefGoogle Scholar
  9. 9.
    The MRC Laparoscopic Groin Hernia Trial Group (1999) Laparoscopic versus open repair of groin hernia: a randomised comparison. Lancet 354:185–190CrossRefGoogle Scholar
  10. 10.
    Hindmarsh AC, Cheong E, Lewis MP, Rhodes M (2003) Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs. Br J Surg 90:1152–1154PubMedCrossRefGoogle Scholar
  11. 11.
    Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89:1476–1479PubMedCrossRefGoogle Scholar
  12. 12.
    Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242:670–675PubMedCrossRefGoogle Scholar
  13. 13.
    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 245:222–231PubMedCrossRefGoogle Scholar
  14. 14.
    Schwab R, Willms A, Kroger A, Becker HP (2006) Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 10:272–277PubMedCrossRefGoogle Scholar
  15. 15.
    Topart P, Vandenbroucke F, Lozac’h P (2005) Tisseel versus tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias: a retrospective analysis. Surg Endosc 19:724–727PubMedCrossRefGoogle Scholar
  16. 16.
    Andrew DR, Gregory RP, Richardson DR (1994) Meralgia paraesthetica following laparoscopic inguinal herniorrhaphy. Br J Surg 81:715PubMedCrossRefGoogle Scholar
  17. 17.
    Broin EO, Horner C, Mealy K, Kerin MJ, Gillen P, O’Brien M, Tanner WA (1995) Meralgia paraesthetica following laparoscopic inguinal hernia repair. An anatomical analysis. Surg Endosc 9:76–78PubMedCrossRefGoogle Scholar
  18. 18.
    Stark E, Oestreich K, Wendl K, Rumstadt B, Hagmuller E (1999) Nerve irritation after laparoscopic hernia repair. Surg Endosc 13:878–881PubMedCrossRefGoogle Scholar
  19. 19.
    Beattie GC, Kumar S, Nixon SJ (2000) Laparoscopic total extraperitoneal hernia repair: mesh fixation is unnecessary. J Laparoendosc Adv Surg Tech A 10:71–73PubMedCrossRefGoogle Scholar
  20. 20.
    Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54PubMedCrossRefGoogle Scholar
  21. 21.
    Hollinsky C, Gobl S (1999) Bursting strength evaluation after different types of mesh fixation in laparoscopic herniorrhaphy. Surg Endosc 13:958–961PubMedCrossRefGoogle Scholar
  22. 22.
    Katkhouda N, Mavor E, Friedlander MH, Mason RJ, Kiyabu M, Grant SW, Achanta K, Kirkman EL, Narayanan K, Essani R (2001) Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair. Ann Surg 233:18–25PubMedCrossRefGoogle Scholar
  23. 23.
    Fortelny RH, Petter-Puchner AH, Walder N, Mittermayr R, Ohlinger W, Heinze A, Redl H (2007) Cyanoacrylate tissue sealant impairs tissue integration of macroporous mesh in experimental hernia repair. Surg Endosc 21:1781–1785PubMedCrossRefGoogle Scholar
  24. 24.
    Jourdan IC, Bailey ME (1998) Initial experience with the use of N-butyl 2-cyanoacrylate glue for the fixation of polypropylene mesh in laparoscopic hernia repair. Surg Laparosc Endosc 8:291–293PubMedCrossRefGoogle Scholar
  25. 25.
    Ceccarelli G, Casciola L, Pisanelli MC, Bartoli A, Di Zitti L, Spaziani A, Biancafarina A, Stefanoni M, Patriti A (2008) Comparing fibrin sealant with staples for mesh fixation in laparoscopic transabdominal hernia repair: a case control-study. Surg Endosc 22:668–673PubMedCrossRefGoogle Scholar
  26. 26.
    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 142:40–46PubMedCrossRefGoogle Scholar
  27. 27.
    Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76PubMedCrossRefGoogle Scholar
  28. 28.
    Mikkelsen T, Werner MU, Lassen B, Kehlet H (2004) Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anesth Analg 99:146–151PubMedCrossRefGoogle Scholar
  29. 29.
    Beldi G, Haupt N, Ipaktchi R, Wagner M, Candinas D (2008) Postoperative hypoesthesia and pain: qualitative assessment after open and laparoscopic inguinal hernia repair. Surg Endosc 22:129–133PubMedCrossRefGoogle Scholar
  30. 30.
    Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DF (1996) Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 276:637–639PubMedCrossRefGoogle Scholar
  31. 31.
    Gerber S, Hammerli PA, Glattli A (2000) Laparoscopic transabdominal preperitoneal hernioplasty. Evaluation of complications due to transabdominal approach. Chirurg 71:824–828PubMedCrossRefGoogle Scholar
  32. 32.
    Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study. Pain in the postrepair patient. Ann Surg 224:598–602PubMedCrossRefGoogle Scholar
  33. 33.
    Gillion JF, Fagniez PL (1999) Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques. Hernia 3:5CrossRefGoogle Scholar
  34. 34.
    Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18:518–522PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Lukas Brügger
    • 1
    Email author
  • Martina Bloesch
    • 1
  • Ramin Ipaktchi
    • 2
  • Anita Kurmann
    • 1
  • Daniel Candinas
    • 1
  • Guido Beldi
    • 1
  1. 1.Department of Visceral Surgery and MedicineBern University Hospital, University of BernBernSwitzerland
  2. 2.Department of Plastic, Reconstructive and Hand SurgeryBern University Hospital, University of BernBernSwitzerland

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