Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation

Abstract

Transfascial sutures are associated with more pain within the first 6 postoperative weeks and less mesh shrinkage after 6 months compared with mesh fixation using metal tacks.

Laparoscopic Incisional Hernia Repair

“…First a sufficient overlap of the mesh and second the mesh fixation. We showed a significant decrease in horizontal mesh size after tack fixation (mean difference -3.1% ±3.9%) versus fixation using sutures (-0.1% ±2.3%; p=0.018) [26]. Mean vertical mesh size was not significantly different between the two groups: tack fixation -2.8% ±6.1%, suture fixation -0.7% ±4.1% (p=0.16).…”

“…Pain after mesh fixation with transfascial sutures is likely due to nerve irritation or entrapment and the relatively small distance between individual sutures used in this study. The significant reduction of pain between 6 weeks and 6 months post operation in these patients could be in response to desensitisation of entrapped nerve fibres or in response to resolution of local inflammation [26]. Asencio et al showed in their study that 22% of the laparoscopic group and 7% of the open group reported significantly pain three months after the operation [13].…”

“…Mean vertical mesh size was not significantly different between the two groups: tack fixation -2.8% ±6.1%, suture fixation -0.7% ±4.1% (p=0.16). Mean mesh area in the tack fixation group was -12% and in the suture fixation group -2.9% at 6 months post operatively when compared to post-op day 2 (p=0.061) [26]. Therefore a sufficient meshoverlap of the hernial orifice is mandatory in order to reduce recurrence rate.…”

“…There is no meta-analysis investigating chronic pain after laparoscopic incisional hernia repair. Postoperative pain after mesh fixation with transfascial sutures is likely due to nerve irritation or entrapmen [26]. There is a randomized controlled trial investigating pain comparing two different techniques of mesh fixation [26].…”

“…Postoperative pain after mesh fixation with transfascial sutures is likely due to nerve irritation or entrapmen [26]. There is a randomized controlled trial investigating pain comparing two different techniques of mesh fixation [26]. Postoperative pain following suture fixation was significantly higher at 6 weeks postoperatively and two patients suffered from nerve irritation at sites of sutures.…”