A Randomized Comparative Study of TEP with and without Mesh Fixation Device

Abstract

This study aims to compare the outcome of Total Extra Peritoneal (TEP) hernia repair procedure with or without using mesh fixation device. A total of 60 patients with clinically diagnosed, non-recurrent, uncomplicated symptomatic inguinal hernias were randomized into two groups: 30 patients to TEP with fixation of mesh and 30 patients to TEP without fixation of mesh. Visual Analogue Scale (VAS) was assessed during the immediate postoperative period at 1, 6, and 24 hrs and at 1 week and at 3 months of follow-up. We analyzed demographic profile, symptoms and examination findings, operative variables, postoperative complications, stay in hospital and cost of treatment. The mean ages were 45.8±13.74 years for the non-mesh fixed group and 55.47±16.74 years for the mesh fixed group. The patients in the mesh fixed group were significantly older than non-fixed group (p=0.017). After 1, 6 and 24 hours of surgery, the mean VAS score was significantly low in non-fixed group (p=0.003, p=0.033 and p=0.047 respectively). After 1 week and 3 months of surgery, the VAS score was comparable in both the groups (p=0.126, p=0.183). The mean duration of surgery in both the groups were comparable (p=0.258). The mean analgesic use in mesh fixed group was 1.42±0.62 and in non-fixed group was 1.18±0.57 which was comparable (p=0.124). Prior to discharge, the mean analgesic use was significantly less in non-fixed group (p=0.003). On comparing complications, urinary retention was significantly less in non-fixed group (p=0.0.028). The mean length of hospital stay and mean time to return to normal activities were significantly less in non-fixed group (p=0.026 and p<0.001 respectively). In non-fixed group, the cost of treatment was significantly low (p<0.001). TEP repair is feasible and safe without mesh fixation device.