pp 1–6 | Cite as

Mesh fixation in open IPOM procedure with tackers or sutures? A randomized clinical trial with preliminary results

  • M. R. LangenbachEmail author
  • D. Enz
Original Article



In open intra-peritoneal onlay mesh (IPOM) hernia repair, mesh fixation can be done by tacks, sutures or fibrin glue. There are randomized controlled trials (RCTs) on laparoscopic IPOM procedure, but no RCT so far has examined mesh fixation techniques in open IPOM repair.


In a single-center RCT, 48 patients undergoing open IPOM repair of an abdominal wall hernia were included. After randomization, surgery was performed in a standardized fashion. Hernia size, extent of mesh fixation, and duration of surgery were documented. The primary endpoint was postoperative pain intensity. Secondary endpoints were: complications, length of stay, quality of life, return to work, hernia recurrence. Follow-up was 1 year in all 48 patients.


After using tacks, mean pain intensity was 16.9, which is slightly lower than after suture fixation (19.6, p = 0.20). The duration of surgery was about the same (83 vs. 85 min). When using tack fixation, significantly more fixation points were applied as compared to sutures (19 vs. 12; p = 0.02), although mesh size was similar. The complication rate was similar (tacks: 6/28 vs. sutures: 3/20). Cost of suture fixation was about 26 €, which is markedly lower than the 180 € associated with tacks. However, surgeons clearly preferred mesh fixation with tacks, because it is more comfortable especially in small hernias.


The present study failed to show an advantage of tacks over suture fixation and even there are more severe adverse events. Using tacks significantly increases the costs of hernia repair.


Open IPOM Mesh fixation Pain intensity Tacks and sutures 


Compliance with ethical standards

Conflict of interest

There is no conflict of interests.

Ethical approval

The university ethics committee approved study protocol and consent form, and the study was registered with the German Clinical Trials Register (DRKS00005743) before start of recruitment.

Human and animal rights

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

Informed consent

All patients gave consent form.


  1. 1.
    Bansal VK, Misra MC, Kumar S, Rao YK, Singhal P, Goswami A, Guleria S, Arora MK, Chabra A (2011) A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc 25(5):1431–1438CrossRefPubMedGoogle Scholar
  2. 2.
    Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, Parra-Davila E, Ramshaw B, Schumpelick V (2010) Hernia repair: the search for ideal meshes. Hernia 14(1):81–87CrossRefPubMedGoogle Scholar
  3. 3.
    Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–585PubMedPubMedCentralGoogle Scholar
  4. 4.
    Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB (2003) What decline in pain intensity is meaningful to patients with acute pain? Pain 105(1–2):151–157CrossRefPubMedGoogle Scholar
  5. 5.
    Christoffersen MW, Rosenberg J, Jorgensen LN, Bytzer P, Bisgaard T (2013) Health-related quality of life scores changes significantly within the first three months after hernia mesh repair. World J Surg 38(7):1852–1859CrossRefGoogle Scholar
  6. 6.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefGoogle Scholar
  7. 7.
    Conze J, Binnebosel M, Junge K, Schumpelick V (2010) Narbenhernie—Wie ist zu verfahren? Chirurgische Standardversorgung. Chirurg 81(3):192–200CrossRefPubMedGoogle Scholar
  8. 8.
    Conze J, Kingsnorth AN, Flament JB, Simmermacher R, Arlt G, Langer C, Schippers E, Hartley M, Schumpelick V (2005) Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair. Br J Surg 92(12):1488–1493CrossRefPubMedGoogle Scholar
  9. 9.
    Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW (2008) Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg 206(4):638–644CrossRefGoogle Scholar
  10. 10.
    Israelsson LA, Smedberg S, Montgomery A, Nordin P, Spangen L (2006) Incisional hernia repair in Sweden 2002. Hernia 10(3):258–261CrossRefPubMedGoogle Scholar
  11. 11.
    Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571CrossRefPubMedGoogle Scholar
  12. 12.
    Klinge U, Conze J, Krones CJ, Schumpelick V (2005) Incisional hernia: open techniques. World J Surg 29(8):1066–1072CrossRefPubMedGoogle Scholar
  13. 13.
    Korenkov M, Sauerland S, Paul A, Neugebauer EAM (2002) Die deutsche Narbenhernienchirurgie im Umbruch. Ein Vergleich zweier Kliniksumfragen 1995 und 2001. Zentralbl Chir 127(8):700–704CrossRefPubMedGoogle Scholar
  14. 14.
    Le Huu Nho R, Mege D, Ouaissi M, Sielezneff I, Sastre B (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149(5 Suppl):e3–14Google Scholar
  15. 15.
    Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398CrossRefPubMedGoogle Scholar
  16. 16.
    Muysoms FE, Deerenberg EB, Peeters E, Agresta F, Berrevoet F, Campanelli G, Ceelen W, Champault GG, Corcione F, Cuccurullo D, DeBeaux AC, Dietz UA, Fitzgibbons RJ Jr, Gillion JF, Hilgers RD, Jeekel J, Kyle-Leinhase I, Kockerling F, Mandala V, Montgomery A, Morales-Conde S, Simmermacher RK, Schumpelick V, Smietanski M, Walgenbach M, Miserez M (2013) Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28–30 June 2012. Hernia 17(4):423–433CrossRefPubMedGoogle Scholar
  17. 17.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Muysoms FE, Novik B, Kyle-Leinhase I, Berrevoet F (2012) Mesh fixation alternatives in laparoscopic ventral hernia repair. Surg Technol Int 22:125–132PubMedGoogle Scholar
  19. 19.
    Nielsen K, Poelman MM, den Bakker FM, van der Ploeg T, Bonjer HJ, Schreurs WH (2014) Comparison of the Dutch and English versions of the Carolinas Comfort Scale: a specific quality-of-life questionnaire for abdominal hernia repairs with mesh. Hernia 18(4):459–464PubMedGoogle Scholar
  20. 20.
    Ritz JP, Holmer C (2005) Onlay, Inlay, Sublay: Wohin mit dem Netz? Hernienchirurgie. Springer, Stuttgart, pp 69–74Google Scholar
  21. 21.
    Beldi G, Wagner M, Bruegger LE, Kurmann A, Candinas D (2011) Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc 25:749–755CrossRefPubMedGoogle Scholar
  22. 22.
    Karakoussis CP, Volpe C, Tanski J, Colby ED, Winston J, Driscoll DL (1995) Use of a mesh for musculoaponeurotic defects of the abdominal wall in cancer surgery and the risk of bowel fistulas. J Am Coll Surg 181:11–16Google Scholar
  23. 23.
    Kaufmann Z, Engelberg M, Zager M (1981) Fecal fistula: a late complication of Marlex mesh repair. Dis Colon Rectum 24:543–544CrossRefGoogle Scholar
  24. 24.
    Weltz AS, Sibia US, Zahiri HR, Schoeneborn A, Park A, Belyansky I (2017) Operative outcomes after open abdominal wall reconstruction with retromuscular mesh fixation using fibrin glue versus transfascial sutures. Am Surg 83(9):937–942PubMedGoogle Scholar
  25. 25.
    Khansa I, Janis JE (2016) Abdominal wall reconstruction using retrorectus self-adhering mesh: a novel approach. Plast Reconstr Surg Glob Open 4(11):e1145CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery II, Helios St. Elisabeth Klinik OberhausenUniversity of Witten/HerdeckeOberhausenGermany

Personalised recommendations