The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias

Prakash, Prajwala S; Wijerathne, Sujith; Salgaonkar, Hrishikesh; Lomanto, Davide

doi:10.1016/j.asjsur.2019.01.010

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…This study was followed in a case–control study of 20 patients undergoing TEP repair by Prakash et al . [ 17 ] in 2019. They too found no difference in pain scores at any of the follow-up time points ranging from six hours to six months postoperatively and no recurrences were identified with the mean follow-up of 24 months.…”

Section: Discussionmentioning

confidence: 99%

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The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

Woo,

Ellis,

Maskal

et al. 2024

Surg Endosc

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Introduction Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up. Methods This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up. Results A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]). Conclusion Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship.

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Section: Discussionmentioning

confidence: 99%

“…The effect of permanent versus absorbable fixation on chronic post-herniorrhaphy groin pain after inguinal hernia repair has been assessed in only a handful of studies with small patient cohorts [ 16 , 17 ]. Comparatively, it has been evaluated in more studies in incisional or ventral hernias.…”

mentioning

confidence: 99%

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

Woo,

Ellis,

Maskal

et al. 2024

Surg Endosc

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“…However, there is a complex interplay between the polymer, textile structure, amount of material, porosity, processing of the material, position and mechanical load on the mesh. Despite some limitations of the available evidence, the HerniaSurge Group stated in the current guidelines [6] that mesh fixation is not required in almost all types of inguinal hernias in TEP repair. However, a strong recommendation for mesh fixation was made for large medial inguinal hernias (MIII in the EHS classification) for TAPP and TEP repair.…”

Section: Discussionmentioning

confidence: 99%

“…In conclusion, a significantly increased risk of injury must be calculated for traumatic mesh fixation techniques, which leads to the fact that only atraumatic mesh fixation methods are recommended in the international guidelines for the laparo-endoscopic treatment of inguinal hernias [6] .…”

Section: Why Traumatic Mesh Fixation In Laparo-endoscopic Inguinal He...mentioning

confidence: 99%

Is mesh fixation in TAPP and TEP still necessary?

Fortelny¹

2021

MIS

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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.

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Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials

Pompeu,

Almiron da Rocha Soares,

Pereira Silva

et al. 2024

Surg Endosc

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The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias

Cited by 9 publications

References 19 publications

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair

Is mesh fixation in TAPP and TEP still necessary?

Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials

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