Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques

Abstract

BackgroundPersistent, activity-limiting pain after laparoscopic ventral or incisional hernia repair (LVIHR) appears to be related to fixation of the implanted mesh. A randomized study comparing commonly used fixation techniques with respect to postoperative pain and quality of life has not previously been reported.MethodsA total of 199 patients undergoing non-urgent LVIHR in our unit between August 2005 and July 2008 were randomly assigned to one of three mesh-fixation groups: absorbable sutures (AS) with tacks; double crown (DC), which involved two circles of tacks and no sutures; and nonabsorbable sutures (NS) with tacks. All operations were performed by one of two experienced surgeons, who used a standardized technique and the same type of mesh and mesh-fixation materials. The severity of the patients’ pain was assessed preoperatively and at 2 weeks, 6 weeks and 3 months postoperatively by using a visual analogue scale (VAS). Quality of life (QoL) was evaluated by administering a standard health survey before and 3 months after surgery. Results in the three groups were compared.ResultsThe AS, DC, and NS mesh-fixation groups had similar patient demographic, hernia and operative characteristics. There were no significant differences among the groups in VAS scores at any assessment time or in the change in VAS score from preoperative to postoperative evaluations. The QoL survey data showed a significant difference among groups for only two of the eight health areas analyzed.ConclusionIn this trial, the three mesh-fixation methods were associated with similar postoperative pain and QoL findings. These results suggest that none of the techniques can be considered to have a pain-reduction advantage over the others. Development of new methods for securing the mesh may be required to decrease the rate or severity of pain after LVIHR.

The Treatment of Incisional Hernia

“…At the 3-month follow-up, no differences were found between the VAS pain scores (30). In a second RCT (n = 68), helical tack fixation in 2 concentric rows (titanium, double-crown technique) caused significantly more pain over a period of up to 3 months postoperatively compared to permanent transfascial sutures (polypropylene) (31).…”

Parietex™ Composite mesh versus DynaMesh®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study

“…[18][19][20][21][22] Our study showed no significant relation between mesh fixation with transfascial sutures and non-absorbable tackers and recurrence of hernia, which is consistent with the existing literature. 23,24 There has been a recent focus on the use of fibrin glue for mesh fixation, particularly in areas such as the subcostal margins and close to the xiphisternum and pelvis. Other studies have emphasised that mesh fixation using fibrin glue in patients with LIVHR is associated with less postoperative pain.…”

Ventral Hernia After Hand-Assisted Laparoscopic Nephrectomy

“…9 This method allows the surgeon to avoid using tacks or transabdominal sutures for suture fixation, which are often cited as the culprit for laparoscopic postoperative pain. 10 The ergonomic features of the robot also give the surgeon the opportunity to create a peritoneal flap for preperitoneal mesh placement to prevent meshrelated intra-abdominal complications and reduce the risk of migration and lateral detachment, which are often cited as the cause of recurrence. 11,12 To date, there are no case reports on the use of the robotic platform to repair a nonmidline ventral hernia from a hand-assist site.…”