Results of Using a New Method of Mesh Fixation During Transabdominal Preperitoneal Inguinal Hernia Repair

Background: Issues concerning necessity, advisability, and the method of mesh fixation during laparoscopic inguinal hernia repair are actively debated. Their solution shall decrease the rate of late mesh-associated complications and improve the quality of life of patients in the long-term postoperative period. We developed an original method of mesh fixation during transabdominal preperitoneal (TAPP) repair (Russian patent RU2814607С1, May 30, 2023).

Objective: To evaluate results of using a new method of mesh fixation during TAPP repair.

Materials and methods: The observational study included 79 patients with inguinal hernias who underwent TAPP repair. All the patients were divided into 3 groups. The main group comprised 27 patients (34.2%) who underwent mesh fixation according to our proposed method. The first control group (standard mesh fixation using a stapler) consisted of 30 patients (38%), and the second control group included 22 patients (27.8%) whose meshes were not fixed. We evaluated the overall complication rate, pain duration and severity, rates of mesh migration or shrinkage, and hernia recurrence rate in the early and long-term postoperative periods. Ultrasonography was used to assess the mesh condition before the discharge and 6 months after the surgery. Quality of life in the long-term postoperative period was measured by the Carolinas Comfort Scale (CCS). The data were analyzed with Statistica 10.0 (StatSoft Inc, USA).

Results: The first control group in which the meshes were fixed with a stapler had significantly higher pain severity and duration in the early postoperative period (U = 17; P= .01) than those of the main and the second control groups. In the first control group there was also a significantly higher rate of early complications compared with the main (P= .008) and the second control groups (P= .006). Six months after the surgery, mesh displacement and hernia recurrence were found in 1 (4.5%) patient from the second control group. No hernia recurrences were observed in the main and the first control group. CCS scores in the main and the second control groups had no significant differences: 27.3 ± 11.2 and 26.8 ± 8.6, respectively. The CCS score in the first control group (44.2 ± 7.3) was significantly lower (U = 14; P= .007) due to a greater number of patients (13.4%) with chronic pain and foreign body sensation in the implantation site.

Conclusions: The proposed method of mesh fixation offers a low rate of postoperative complications and sufficient reliable mesh fixation, thus improving quality of life postsurgery.

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