A comparative study of mesh fixation versus nonfixation in laparoscopic totally extraperitoneal inguinal hernia repair

Background Inguinal hernia repair is one of the most common elective general surgical procedures, and laparoscopic inguinal hernia repair has become very popular procedure, accounting for 15-20% of hernia operations worldwide. Aim of the work This study was conducted to compare mesh fixation versus nonfixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Patients and methods This study is a prospective randomized comparative study that was carried out in the Gastrointestinal and Laparoscopic Surgery Department of Tanta University Hospitals for a year on 40 patients with inguinal hernia who underwent TEP inguinal hernia repair. They were randomized into two equal groups (20 cases): group A: with mesh fixation and group B: without mesh fixation. Results All patients of both groups were males. Group A had a longer operative time than group B (P=0.018). There was no significant difference in postoperative pain in both groups (P=0.6). One (5%) patient in each group had an accidental peritoneal tear. No cases needed conversion. Drain was inserted in one (5%) patient in each group (P=1). No cases had seroma or hematoma formation or chronic groin pain in both groups. One (5% each) patient in each group had scrotal edema, and postoperative surgical emphysema was present in two (10%) patients in each group. No cases of postoperative wound infection or mesh infection were seen in both groups. There was a recurrence in one patient in group B (after 1 week postoperative). The mean hospital stay is statistically insignificant in between both groups. The mean total cost is much higher in group A than group B (P<0.001). Conclusion On comparing mesh fixation or nonfixation in laparoscopic TEP repair for inguinal hernia, we recommend the technique without mesh fixation as there were no differences in the complications, hospital stay, or recurrence, but longer operative time and higher cost were seen in mesh fixation technique.