A comparative clinical trial of totally extraperitoneal groin hernia repair with or without mesh fixation

Abstract

The need of mesh fixation in total extra-peritoneal laparoscopic (TEP) inguinal hernioplasty is still controversial issue. The question is important because mesh fixation has been related to post-operative pain, recurrence and increased hospital cost. Whereas various other studies have been done that showed non fixation of mesh is safe, cost effective, associated with less pain, and leads to no increased risk of hernia recurrence .Keeping this in view and resolve the controversial issue, the study was carried out to compare the safety and efficacy of laparoscopic totally extra peritoneal groin hernia repair with and without mesh fixation and in relation to post-operative morbidity in these two group of patients. Methods: Patients were randomized into two groups of 30 each , where a total of 64 repairs were done.In mesh fixation group the mesh was fixed and no fixation was done in other group. Results: The present study showed no statistically significant difference in demographic factors, recurrences, chronic pain seroma in either group. Although the cost was higher in mesh fixation group where tacks had been used as compared to non mesh fixation group. Moreover fixing the mesh in the extra peritoneal space increases the operating time and cost of the repair. Conclusion: In this study we concluded with reasonable confidence that totally extraperitonally groin hernia repair performed without mesh fixation is safe , feasible and cost effective without any increased incidence of early reoccurrence.