Mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal bilateral inguinal hernia repair without mesh fixation

Purpose: International guidelines recommend laparoscopic surgical repair for bilateral inguinal hernia. One of the laparoscopic procedures with rapid recovery, less chronic pain and less chance of infection is enhanced totally extraperitoneal (eTEP). The eTEP technique is useful in bilateral hernias, large inguinal-scrotal hernias, incarcerated hernias, obese patients and patients with a short distance between the umbilicus and pubic tubercle. However, eTEP inherently involves extensive extraperitoneal dissection. Both bilateral hernia repair and the use of the eTEP technique reveal that the extraperitoneal space is even larger. This can be considered as a factor for mesh displacement. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in bilateral laparoscopic inguinal hernia repair. Methods: Form January 2023 to June 2023, 40 consecutive patients with bilateral inguinal hernia were randomized into two groups; eTEP group (n = 20) and TEP group (n = 20) without mesh fixation. Study was registered at http://Clinicaltrials.gov (NCT06070207). The meshes were marked with three radiopague clips. Pelvic radiographs was performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP technique in terms of mesh displacement without fixation in laparoscopic bilateral inguinal hernia. Results: There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, operation time, length of hospital stay, accidental pneumoperitoneum, hematoma, seroma formation and surgical site infection. Conclusion: There was no more mesh displacement in the eTEP group in which more extraperitoneal space was created. Both bilaterality and without mesh fixation did not cause any difference in mesh displacement in both groups. Despite both bilaterality and larger extraperitoneal space dissection, the absence of mesh fixation in the bilateral eTEP technique is safe. Mesh displacement in laparoscopic bilateral inguinal hernia repair is minimal and similar in the TEP and eTEP technique. Trial registration clinicaltrials number: NCT06070207. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).