Is mesh fixation in TAPP and TEP still necessary?

Abstract

One of the most serious complications after inguinal hernia repair is still the occurrence of chronic pain. The literature describes rates of severe chronic pain of 3%-6%. Laparo-endoscopic inguinal hernia repair is favored to prevent postoperative pain through a minimally invasive approach and sparing of the layers of tissue covering nerves and vessels in terms of reduced risk of damage to these structures. However, the method of fixation of the mesh is still controversial discussed. The use of these penetrating devices such as staples and staplers has been shown to often be complicated by injury to nerves and vessels and occurrence of postoperative pain. The shift to completely atraumatic fixation using adhesives (fibrin glue, cyanoacrylate) began in the early part of this century. Several studies confirmed less postoperative pain after mesh fixation by glue compared to stapler or tacker. Historically, the TEP technique has always been performed without any fixation. Several studies comparing fixation versus non-fixation have been performed in TEP repair and found results with no increase in recurrence rate. Notwithstanding that very few studies comparing fixation versus no fixation with exclusion of large medial inguinal hernias have been published on this topic in TAPP repair, identical results to those with TEP repair were obtained. On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair except for large medial and combined inguinal hernias. If mesh fixation is required, atraumatic techniques should be used.

Laparoscopic Totally Extra Peritoneal Inguinal Hernia Repair with Endoscope Preperitoneal Dissection and No Mesh Fixation - How I Do It

“…Multiples studies in literature have not observed any difference in hernia recurrence between mesh fixation and non-mesh fixation in TEP repair of an inguinal hernia. The mesh fixation with tackers or suture might expose to the risk of entrapment of the nerve and the apparition of chronic postoperative inguinal pain (14)(15)(16). If the fixation is necessary, in exceptional cases, non-traumatic techniques as the use of surgical glue can be a feasible option.…”

Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials

“…However, other studies believe that the fixation of mesh is related to nerve injury, foreign body sensation in the operation area and chronic pain. The authors of these studies advocated that the mesh should not be fixed during TEP inguinal hernia repair [ 10 , 11 ]. The aim of this study is systematically analyzed published controlled clinical trials (RCTs) to compare the treatment outcomes of unfixed mesh versus fixed mesh in TEP inguinal hernia repair.…”