Laparoscopic Tapp Inguinal Hernia Repair: Mesh Fixation With Absorbable Tacks, Initial Experience

Abstract

Background: Preliminary studies have indicated advantages of mesh fixation using fibrin glue in TAPP compared with tack fixation. Objectives: We report the results of a prospective experience in fixing mesh during TAPP with absorbable tacks. Patients and Methods: 50 consecutive men (who had bilateral inguinal hernia) were enrolled and followed up for at least 1 year. The primary measured outcome was pain experienced in day 1 of post-op. The secondary outcomes measured were postoperative scores of pain at rest, discomfort, and fatigue, foreign-body sensation, and hernia recurrence after 12 months. The outcomes were measured using a visual analogue scale, a verbal rating scale and numerical rating scales. A comparison was done within a historical group with the same demographic and hernia characteristics where the meshes have been fixed with fibrin glue. Results: The group of tacks 'TAPP' showed good results concerning the level of pain, fatigue and foreign body sensation comparable with those of the historical group. There were significant differences concerning the length of surgery where absorbable tacks performed better. Regarding cost of surgery, the fibrin glue showed effective results. Conclusions: The use of absorbable tacks during TAPP confers significant benefit regarding the operating time, however it is a disadvantage due to the cost when compared with fibrin glue.

Postoperative Pain and Recurrence after Mesh Fixation with Absorbable versus Non-Absorbable Tacks in Patients undergoing Laparoscopic Transabdominal Inguinal Hernia Repair: A Comparative Study

“…The mean number of tacks was 16.87±3.22 in group A and 19 (13)(14)(15)(16)(17)(18)(19)(20) with mean 17.4±2.92 in group B. This is comparable with other studies.…”

“…This is comparable to the results of Agresta et al study. 13 The postoperative pain assessment results in this study are comparable to other studies. In a multicenter study assessing the use of absorbable tacks as regard postoperative pain revealed that at 1 month, 90% of patients were totally pain-free (VAS score: 0) and only ten patients reported low pain (VAS scores: 0.3-3.1).…”

“…This is comparable to other studies; Agresta et al study where all procedures were performed as day cases and all the patients were discharged before 8 pm in surgery day. 13 In Sharma et al study, the mean hospital stay was 52.0±14.21 h. 14 Postoperative complications included inguinoscrotal edema; 2 patients in group A and 1 patient in group B, all were treated conservatively within 2 weeks. One patient in group B had port site infection and this was the only case of readmission for drainage.…”

“…15 In Agresta et al study, VAS score was 6±3 after 12 month. 13 In Sharma et al study, early post operative pain was assessed by VAS score which was 3.40±1.37 and 0.93±0.64 at 24 h and 48 h postoperative, respectively. 14 Other results from this study were comparable to other studies on TAPP using tacks as regard operative time, intraoperative complications, hospital stay, postoperative complications and return to normal activity.…”

“…In a study done by Agresta et al on 50 patients with bilateral inguinal hernia Agresta et al used 3 absorbable tacks for mesh fixation and 4-5 tacks for peritoneal closure on each side. 13 In Sharma et al study, 4-8 tacks were used for each side for fixing meshes to Cooper's ligament and anterior abdominal wall and another 7-9 more tacks had to be used for each side in the TAPP Group for repositioning both the flaps. Tacks used in the TAPP group were 16.53±1.28 but the type of tacks was not mentioned in the study.…”