Lack of advantages of slit mesh placement during laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP): a single centre, case matched study

Background: During laparoscopic trans-abdominal pre-peritoneal hernia repair (TAPP) the positioning of the mesh around the spermatic cord could provide an additional anchoring point and ensure better defect closure, thereby preventing mesh movement and recurrence. The primary aim of our retrospective study was to determine if, during a TAPP procedure, an advantageous difference for mesh placement exists between the slit and the non-slit techniques in terms of recurrence rate. Secondary aims were intra and post-operative complications and the time required to return to normal activity. Methods: From January 2010 to December 2015, data from patients who had undergone TAPPs at our Institution were prospectively collected. We performed a retrospective case control matched study of two homogenous (BMI, Age, type of hernia) groups of 100 patients who underwent respectively TAPP with no slit mesh placement (Group NS) and slit mesh placement (Group S). Statistical analysis was carried out using a SPSS 20. To compare continuous variables, an independent sample T-test was performed. A Chi-square test was employed for categorical data. Results: No differences were found between the slit and non-slit groups in terms of biometric features and intra and post-operative outcomes were found to be similar in both groups as well. In particular, at mean follow-up of 57.34 +/- 10.56 months for Group NS and 55.66 +/- 8.61 months for Group S months only one recurrence per group was found. Conclusion: Our study failed to prove a superiority of the slit mesh technique over the no-slit mesh technique during TAPP. However, in light of its not being a randomized study, a subsequent, well-designed RCT would be desirable in order to better determine if the Slit mesh technique could prove to be advantageous enough to justify its routine use during the TAPP procedure.