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Background This was a prospective, multicentre, non-blinded, randomized clinical trial involving two parallel groups of patients. Methods Adult patients with symptomatic unilateral primary inguinal hernia were included in this study. Patients were enrolled and treated in five Finnish hospitals. Eligible patients were randomized by use of a computer-based program to receiving either open anterior repair (modified Lichtenstein) with glue mesh fixation or totally extraperitoneal (TEP) repair. The primary aims were to compare 30-day patient-reported pain scores and return to work after surgery between the two groups. Results A total of 202 patients were randomized: 98 patients to TEP repair and 104 patients to open repair. All randomized patients received their allocated treatment. A total of 86 patients (88 per cent) in the TEP group and 94 patients (90 per cent) in the Lichtenstein group completed the 30-day follow-up. Patients experienced less early pain (P Conclusion TEP inguinal hernia repair is associated with less early postoperative pain compared to the open glue mesh fixation technique. Trial registration NCT03566433 (http://www.clinicaltrials.gov).

Background and Objectives: There are weak data comparing the safety and efficacy of absorbable and permanent tacks in laparoscopic ventral hernia repair with tack-only mesh fixation. In this study,...

Background and Objective: Inguinal hernia is one of the most common type of hernia affecting both genders. New surgical interventions to repair hernia are being developed for the better outcome of patients by reducing the operative time and postoperative complications. The objective of this study was to compare the prolene sutures and skin staples for mesh fixation in inguinal hernioplasty with mean operative time and post-operative pain as outcome determinants. Methods: This randomized controlled trial was conducted in the Department of General Surgery, DHQ Teaching Hospital, Sahiwal Medical College, Pakistan from January 1st, 2019 to December 31st, 2019. A total of 180 patients admitted for hernioplasty were recruited after institutional ethical approval. The study participants were randomized into group A and B. Mesh fixation was done by using prolene suture in group A, while skin staples were used in group B. The duration of procedure and post-operative pain after 1 week was noted using visual analogue scoring system. The comparison between groups was done through independent sample t-test. p-value < 0.05 was considered to be statistically significant. Results: Mean age of the patients in group A and B was 39.21 ± 11 years and 40.16 ± 5.72 years respectively. The mean operative time was 52.15 ± 9.78 minutes in group A and 36.92 ± 3.95 minutes in group B (p = 0.000). Post-operative pain after 1 week was reported in 26.7% cases in group A while it was seen in only 10% cases in group B (p = 0.004). Conclusion: The outcome determinants of mean operative time and postoperative pain after inguinal hernioplasty were better achieved in cases treated by skin staples as compared to prolene sutures.

Objective: Inguinal hernia repair is one of the most common general surgical procedure, and laparoscopic approach gained popularity over the open approach. This study aimed to compare the clinical effects of TEP inguinal hernioplasty with or without mesh fixation. The primary outcome was acute post-operative pain. Material and Methods: A retrospective comparative study on a prospectively collected data was conducted in a large DGH in England between Janu- ary 2017 and December 2019 on 47 patients. The patients were divided into two groups. In group A, mesh fixation was performed with absorbable tackers and in group B no fixation was performed. Patients were followed up to 18 months postoperatively. Data was collected on post-operative pain, cost, recurrences and time taken to return to normal activities. Patients with lower midline scar and complicated inguinal hernias were excluded. Results: Out of the 47 patients 53% (n= 25) were in group A and 47% (n= 22) in group B. All the patients in both groups were male. The mean postopera- tive pain score at 72h in group A was 7.12 (SD 1.13) and 4.91 (SD 1.23) in group B (p< 0.001). Group B patients have taken shorter time to return to normal activities in comparison to group A (p< 0.001), while recurrence (2%) rate is higher in group B (p> 0.05). Conclusion: Pain and time taken to return to normal work postoperatively were significantly less in the non-fixation group. The study recommends non-fixation over fixation as it is feasible, cost-effective, causes less post-operative pain and no differences in terms of recurrences.

BACKGROUND Prophylactic mesh augmentation (PMA) is an effective technique utilized to reduce the risk of incisional hernia. This study analyzes the biomechanical characteristics of a mesh-reinforced closure and evaluates a novel prophylactic mesh implantation device (SafeClose Roller System; SRS). MATERIALS AND METHODS A total of eight senior-level general surgery trainees (≥4 years of training) from the University of Pennsylvania Health System participated in the study. Biomechanical strength, mesh stiffness, mesh uniformity, and time efficiency for fixation were compared among hand-sewn mesh fixation, SRS mesh fixation and a no-mesh fixation control. Porcine abdominal wall specimens served as simulated laparotomy models. RESULTS Biomechanical load strength was significantly higher for mesh reinforced repairs (P = 0.009). The SRS resulted in a stronger biomechanical force than hand-sewn mesh (21.2 N stronger, P = 0.317), with more uniform mesh placement (P

Choice of the best possible fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of the present study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Fourteen Landrace swine were utilized in the study. The experiment included two stages. Initially, four pieces of mesh (Ventralight ™ ST) sizing 10 × 5 cm were placed and fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. These defects were repaired primarily with absorbable suture before mesh implantation. Each mesh was anchored with a different tack device between Absorbatack™, Protack™, Capsure™, or Optifix™. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy via U-shaped incision to obtain the measurements for the outcome parameters. The primary endpoint of the study was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Capsure™ tacks had higher peel strength when compared to Absorbatack™ (p = 0.028); Protack™ (p = 0.043); and Optifix™ (p = 0.009). No significant differences were noted regarding the extent of visceral adhesions (Friedman’s test p value 0.854), the adhesion quality (Friedman’s test p value 0.506), or the mesh shrinkage (Friedman’s test p value = 0.827). Four out of the ten animals developed no adhesions at all 2 months after implantation. Capsure™ fixation system provided higher peel strength that the other tested devices in our swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

Introduction A neovaginal prolapse is a rare condition. Only a few cases have been reported and described in literature. The surgical management is complex and depends on the initial surgical techniques for the reconstruction of a neovagina applied. We present a case of a stage IV prolapse of a sigmoid vaginal prolapse and a review of surgical procedures in literature. Methods We describe the case of a 41-year-old woman with a stage IV prolapse of a sigmoid neovagina who presented 20 years after the initial reconstruction due to a botryoid sarcoma of the pelvis in the childhood. The initial surgical repairs with a fixation of the apex of the sigmoid vagina to the sacral promontory with resorbable suture and consecutively in a second procedure with a polypropylene mesh failed. The interdisciplinary approach with the colorectal team which included a significant shortening of the neovagina prior to the mesh fixation led to a stable repair of the prolapse. Conclusion Only a few cases of women with a prolapse of a sigmoid neovagina are published. An interdisciplinary approach including a significant shortening of the neovagina and the fixation with a non-absorbable mesh was necessary to achieve a successful repair. The surgical techniques to create a sigmoid neovagina are crucial in order to perform successful later reconstructive surgery if indicated. Our experience in this case is consistent with the findings from our literature review.

To sum all available evidence regarding mesh or mesh fixation material intestinal erosion following inguinal hernia repair and identify the parameters that lead to early ( 6 months) symptom presentation. A systematic literature search of the MEDLINE, Scopus and Google Scholar databases was undertaken to identify relevant studies published up to June 2020. A total of 54 case reports or cases series, incorporating 57 intestinal erosions were identified. Overall, 13 patients (23%) experienced early intestinal erosions occurring during the first 6 postoperative months while the remaining 44 events (67%) occurred after 6 months. Patients presented most commonly with symptoms of acute obstruction (n = 18, 31.5%), followed by signs of a palpable inguinal mass in 15 patients (26.3%). The late presentation group exhibited significantly more cases of mesh erosion when compared to the early presentation group (100% versus 46.2%, respectively, p

Objective: To compare the recurrence rate and chronic pain in hernia patients undergoing laparoscopic or robotic transabdominal preperitoneal fixation with and without mesh. Method: The prospective comparative study was conducted at Surgical Units 4 and 5 of the Civil Hospital, Karachi, from August 1, 2017, to July 1, 2018, and comprised hernia patients undergoing laparoscopic or robotic transabdominal preperitoneal fixation who were randomised into fixation Group A and non-fixation Group B. Postoperative visual analogue scale score was calculated at the time of discharge. At 1-year follow-up, recurrence rate and chronic pain were assessed. Data was analysed using SPSS 23. Result: Of the 98 patients, there were 49(50%) in each of the two groups. Of the total, there were 97(99%) males. The overall mean age was 44.52±14.51 years. The differences in visual analogue scale scores at the time of discharge and the mean discharge from the hospital in terms of days were statistically significant (p0.05). Chronic pain between the groups was not significant (p>0.05). Conclusion: There was no significant difference in terms of recurrence and chronic pain between mesh and non-mesh fixation. Key Words: TAPP, Transabdominal preperitoneal, Laparoscopic TAPP, Robotic TAPP, Mesh fixation, Tacker fixation. Continuous...

Background: Laparoscopic repair of groin hernia is gaining popularity, most surgeons follow up the consensus of mesh fixation especially by tissue penetrating methods, as mesh fixation helps prevent recurrence it also, may cause nerve injuries leading to acute and/or chronic postoperative pain, many alternatives for mesh fixation do exists as use of self-gripping mesh, use of absorbable tacks, use of fibrin glue and the mesh placement in the extra-peritoneal space without fixation as we tried to investigate in this study. Patient and method: 46 patients undergoing laparoscopic trans-abdominal preperitoneal repair of groin hernia were randomly allocated into two equal groups, A (group of mesh fixation with absorbable tacks) and B (group of mesh no fixation). Preoperative, operative, and postoperative data in both groups, namely recurrence rate, acute and chronic pain, and local complications were statistically analyzed in comparison to each other. Results: Throughout the analysis of the data there were no statistically significant differences between both groups regarding demographic data, hernia side, and hernia type. the operative time, acute pain score, and incidence of chronic pain were longer in the fixation group without statistical significance, we recorded one case of recurrence in the non-fixation group but without statistical significance. Conclusion: Mesh placement in the preperitoneal space during laparoscopic trans-abdominal pre-peritoneal repair of inguinal hernia is a safe efficient method as it is not associated with increased recurrence rate or postoperative pain.

Laryngeal fractures are though uncommon they can be potentially life threatening. Comminuted laryngeal cartilage fractures are difficult to manage and various fixation techniques have been described in literature. Outcome results of fixation with different materials can be varied. We report a case of 27 years old male who sustained laryngeal cartilage fracture following accidental fall. Patient underwent emergency tracheostomy and early surgical repair of fractured laryngeal thyroid cartilage with one of the newest techniques "titanium mesh fixation". After a month of surgery tracheostomy tube was removed and patient recovered with good laryngeal function. Titanium mesh fixation gave immediate effective fixation and stability to laryngeal fracture leading to good surgical outcome.

Background: Inguinal hernia repair is the most common procedure in general and visceral surgery worldwide. Over the past two decades, laparoscopic inguinal hernia repair has become more and more popular. Objective: To enhance outcome of TEP, test feasibility, and count the cost of mesh fixation using staples and non-mesh fixation. Patients and methods: This study was conducted in Theodor Bilharz Research institute [TBRI] and Al-Azhar University Hospitals during the period from December 2017 to April 2019.This study included 40 patients with inguinal hernia underwent TEP repair. Patients were divided in to two equal groups: Group A include patients underwent TEP repair with no mesh fixation, and Group B underwent TEP repair using tack fixation of mesh. Results: Regarding operative time, it was slightly longer in mesh fixation group. No intraoperative complications have been encountered in groups including bleeding, peritoneal tear or visceral injuries. Regarding postoperative period, there was no difference in the postoperative parameters between both groups including pain, hospital stay and recurrence. Conclusion: Totally extra-peritoneal approach (TEP) was an acceptable procedure for inguinal hernia repair with less visceral and vascular injuries. No difference in outcome between mesh fixation and non-mesh fixation in TEP repair of inguinal hernia.

Introduction: Hernias may be generally defined as a protrusion of abdominal viscera outside the abdominal cavity through a natural or acquired defect. Transracial sutures penetrate all layers of the abdominal wall, thereby enable fixation of the mesh to the entire fasciomuscular layer of the abdominal wall. In the present study, a comparison between the two most common methods of mesh fixation, i.e. tackers versus sutures was done. Materials and Methods: The totals of 100 patients were included in the study. The study was conducted in the department of the surgery for a period of one year. All the included patients were admitted for laparoscopic repair of primary or ventral hernia. All the patients included in the study were divided into two groups. Group A: patients with tacker fixation and Group B: Suture mesh fixation. Results: Although all the patients in the study presented with swelling in the abdominal region, associated pain was present in 56 of patients, 28 presented with irreducibility, 10 with obstruction, and only 6 patients showed the features of strangulation. The operative time was significantly higher in Group II. Patients in Group I experience more pain post-operatively. The incidence of seromas was higher in Group II. The cost of surgery was significantly higher in Group I compared to Group II. Conclusion: No major complications were encountered during or after the procedure. The formation of seromas was higher in suture fixation. In group A the use of tacks was costly as compared to group B. In the small-sized defect and in anatomical areas, the suture fixation was a better alternative as compared to tacker fixation.

The review is devoted to the treatment methods of inguinal hernia. Inguinal hernia repair is one of the most common operations in the world and is performed on more than 20 million patients per year. Recurrence rates of inguinal hernias after different types of surgical interventions range from 10 to 15%. The use of synthetic materials reduced the rates of hernia recurrence on average to 1-5%. Currently there are traditional tissue-based techniques, open tension-free mesh hernia repair, and laparoscopic mesh hernioplasty. Nowadays tension-free repair with synthetic mesh is a technique of choice for inguinal hernia repair. The emphasis has been placed on endoscopic methods of inguinal hernia prosthetic repair. According to the literature, laparoscopic repair is associated with low rates of wound infection and fewer haematomas, which leads to early resumption of everyday activities compared with Lichtenstein hernia repair. The paper discusses two standardized endoscopic methods for inguinal hernia treatment, namely laparoscopic transabdominal preperitoneal patch (TAPP) and total extraperitoneal (TEP) repair. Analysis of the literature has shown that criteria of necessity and method of mesh fixation during TAPP procedure were not completely identified. However, a number of researches have demonstrated that TAPP technique without mesh fixation proved to be a safe procedure which can be used in most patients with unilateral and bilateral inguinal hernia showing no increase in postoperative complications and low recurrence rates.

Background In open retromuscular ventral hernia repair, fixation-free mesh placement is increasingly prevalent and may minimize pain; the main concern with this technique is short-term technical failure and hernia recurrence. This study compared outcomes following mechanical mesh fixation (i.e., sutures, staples, tacks) versus fixation-free mesh placement. Methods Adults who underwent open, elective, retromuscular ventral hernia repair of 15 cm width or less with permanent synthetic mesh placement in a clean wound were identified. Propensity score matching was used to compare patients who received mechanical mesh fixation to those who received fixation-free mesh placement. Thirty-day hernia recurrence was the primary outcome, with secondary outcomes of 30-day hospital length of stay and 30-day rates of readmission, reoperation, wound events, pain, and abdominal wall function. One- and 2-year composite recurrence and 3-year cumulative composite recurrence were also evaluated. Results A 3:1 propensity score match was performed on 299 fixation-free patients identifying 897 mechanical fixation patients, with a mean body mass index of 31 kg/m and mean age of 57.5 years. There was no difference in 30-day recurrence between mechanical and fixation-free approaches (0.2 percent versus 0 percent; p = 1). Median length of stay was longer for mechanical fixation (4 versus 3 days; p = 0.002). In the mechanical fixation group, pain scores were higher (worse pain, 46 versus 44; p = 0.001), and abdominal wall function scores were lower (worse function, 47 versus 60; p = 0.003), with no differences in rates of hospital readmission, reoperation, or wound events. There were no differences in long-term outcomes of 1- and 2-year composite recurrence, or 3-year cumulative composite recurrence. Conclusion For short-term technical durability, fixation-free mesh placement in open retromuscular ventral hernia repair is an acceptable alternative to mechanical fixation for hernia defects of 15 cm or less. Clinical question/level of evidence Therapeutic, III.

This study aims to compare the outcome of Total Extra Peritoneal (TEP) hernia repair procedure with or without using mesh fixation device. A total of 60 patients with clinically diagnosed, non-recurrent, uncomplicated symptomatic inguinal hernias were randomized into two groups: 30 patients to TEP with fixation of mesh and 30 patients to TEP without fixation of mesh. Visual Analogue Scale (VAS) was assessed during the immediate postoperative period at 1, 6, and 24 hrs and at 1 week and at 3 months of follow-up. We analyzed demographic profile, symptoms and examination findings, operative variables, postoperative complications, stay in hospital and cost of treatment. The mean ages were 45.8±13.74 years for the non-mesh fixed group and 55.47±16.74 years for the mesh fixed group. The patients in the mesh fixed group were significantly older than non-fixed group (p = 0.017). After 1, 6 and 24 hours of surgery, the mean VAS score was significantly low in non-fixed group (p=0.003, p=0.033 and p=0.047 respectively). After 1 week and 3 months of surgery, the VAS score was comparable in both the groups (p=0.126, p=0.183). The mean duration of surgery in both the groups were comparable (p=0.258). The mean analgesic use in mesh fixed group was 1.42±0.62 and in non-fixed group was 1.18±0.57 which was comparable (p=0.124). Prior to discharge, the mean analgesic use was significantly less in non-fixed group (p=0.003). On comparing complications, urinary retention was significantly less in non-fixed group (p=0.0.028). The mean length of hospital stay and mean time to return to normal activities were significantly less in non-fixed group (p=0.026 and p

Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. Few studies exist to support a standard protocol for repair of these lateral hernias. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. A retrospective review of all patients who underwent lateral hernia repair at our institution was performed. Eight cases (seven flank and one thoracoabdominal) were reviewed. The median defect size was 105 cm2 (range 36–625 cm2). The median operative time was 185 min (range 133–282 min). There were no major complications. One patient who was repaired without mesh attachment to bony landmarks developed a recurrence at ten months and subsequently underwent reoperation. Patients with mesh secured to bony landmarks were recurrence free at a median follow-up of 171 days. Lateral hernias present a greater challenge due to their anatomic location. An open technique with mesh fixation to bony structures is a promising solution to this complex problem.

The article is devoted to the evolution of fixation methods for synthetic mesh endoprostheses in surgery of inguinal hernias. We have analyzed the data on failures and complications of synthetic implants. We paid a special attention to available techniques, such as endoprostheses fixation without sutures as well as to the fixation using various types of glue. Our review is based on its own experimental and clinical data as well as the data from world's best hospitals. We found that the use of fibrin glue frequently leads to formation of seromas and hematomas, whereas albumin-glutaraldehyde glue may result in abscesses and pyogenic inflammatory infections of surgical sites. The authors pointed out the importance of further research for the optimal fixation of the prosthetic mesh in hernia repair.

BACKGROUND: Fixation of mesh in pre-peritoneal space is an important step in laparoscopic TAPP hernia repair. Mesh dislocation is one of the most frequent causes responsible for recurrence. Of the many factors inuencing postoperative pain, the technique of xation has been reported to be one of the most signicant determinants. So mesh xation with adhesives instead of mechanical devices has been proposed as a mean to reduce the incidence of postoperative pain. AIM: To compare clinical outcome and morbidity of xation of mesh using brin glue and tackers in trans-abdominal pre-peritoneal inguinal hernia repair METHODOLOGY: We did a prospective randomized comparative study in which we enrolled 50 patients undergoing laparoscopic hernia repair (TAPP). Those who met our inclusion criteria were randomized for study purpose after obtaining informed consent, in 25 patients mesh xed with tackers (group A) and in other 25 patients mesh xed with brin glue (group B). Patients were compared for intraoperative time required for mesh xation, early and late postoperative pain, time required to resume normal daily physical activity, length of hospital stay, hernia recurrence and seroma formation. Postoperative follow up was done up to six months. RESULTS: Two groups were comparable in terms of demographic variables. We observed that postoperative pain, time required resuming normal daily activity and incidence of seroma formation was less in group B (Mesh xed with glue). There was no signicant difference in length of hospital stay in both groups and no evidence of hernia recurrence in both groups during follow up period. CONCLUSION: It can be concluded that xation of mesh with brin glue when compared with tackers, seems to reduce postoperative pain, time to resume daily activities and incidence of seroma formation with no difference in length of hospital stay, early hernia recurrence with longer operative time.

A 52-year-old female underwent laparoscopic repair for recurrent epigastric hernia by hybrid natural orifice transluminal endoscopic surgery. Three 5-mm abdominal trocars and a 15-mm transvaginal trocar were used. The defect was closed by intracorporeal suturing before mesh fixation. She was discharged uneventfully on the 2nd post-operative day. Intracorporeal closing the defect may reduce the bulging of the mesh in laparoscopic ventral hernia repair. This case is the first hybrid transvaginal ventral hernia repair using defect closure technique.

Aim Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation. Material and Methods Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks. Results Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints. Conclusions Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.

Aim The HerniaSurge guidelines concerning mesh and fixation options in laparoscopic totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. We hypothesized that the value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The present registry-based nationwide cohort study compared different mesh/fixation combinations regarding relative risks for reoperation after TEP and TAPP. Material and Methods All TEP and TAPP with standard polypropylene (StdPPM) or lightweight (LWM) flat meshes, combined with either tacks, fibrin glue, or no fixation, registered in the Swedish Hernia Registry 2005-2017 were included. Endpoint was reoperation due to recurrence as of December 31, 2018. Multivariable Cox regression rendered relative risk differences between the exposures, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Results Of 25 190 repairs, 924 (3.7%) were later reoperated for recurrence. The lowest, mutually equivalent, reoperation risks were associated with StdPPM without fixation (HR 1), StdPPM with metal tacks (HR 0.8, CI 0.4-1.4), StdPPM with fibrin glue (HR 1.1, CI 0.7-1.6), and LWM with fibrin glue (HR 1.2, CI 0.97-1.6). LWM correlated otherwise with increased risk, whether without fixation (HR 2.0, CI 1.6-2.6), or affixed with metal (HR 1.7, CI 1.1-2.7), or absorbable tacks (HR 2.4, CI 1.8-3.1). Conclusions With StdPPM, fixation seems not to improve outcomes, despite being costlier. Thus, for this mesh category, we recommend non-fixation. With LWM, we recommend fibrin glue fixation, which was the only LWM alternative on par with non-affixed StdPPM.

Aim Study of postoperative outcomes after Liechtenstein inguinal hernia repair using self-gripping mesh and polypropylene mesh with suture fixation. Material and Methods Medical records of 289 open inguinal hernia repairs were analyzed: 176 – with sutured polypropylene mesh and 113 – using self-gripping mesh. To assess the quality of life we have used EuraHS Qol and SF-36. Statistical analysis was performed using SPSS. Results There were no significant differences in wound complications (such as swelling, seroma, hematoma, orchitis) between these groups (p > 0,05). The duration of operation was significantly shorter with self-gripping mesh compared to sutured mesh (42,2 min. sd = 23,42 vs 58,5 min. sd = 16,70; p Conclusions Self-gripping mesh has comparable outcomes with sutured polypropylene mesh regarding the frequency of wound complications and quality of life on long-term follow-up. However, self-gripping mesh is associated with reduced operation time, pain in the short-term postoperative period, and taking NSAIDs compared to sutured mesh.

Aim Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms. Material and Methods Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74-136) were operated on prior to the outbreak of COVID-19. Post-operative pain is the primary trial outcome. Surgery was performed with either spiral-tack mesh-fixation device (Protack (permanent) or Reliatack (absorbable)), Symbotex IPOM mesh, and fascial closure with no 1 Maxon suture(s) using extracorporeal knot ties – the Manchester Technique. Data was collected on trial forms and lifestyle questionnaires (SF-36 and CCS). All data were explored and described in RStudio v1.4.1106. Results Patients were aged 36-80 and 36(57.1%) patients were male. Mean preoperative BMI was 30.91(sd5.11,range21.15–43.93). Mean operating time was 80.81(37.34,20-240)minutes. In 13(20.6%) patients multiple hernia defects were identified. A good degree of fascial closure was achieved in all patients using a median of 3(IQR 2.0-3.5)knots. Median mesh-fixation time was 286(159.5-428.0)seconds and a mean 25.24(5.49,14-41)tacks/patient were used. Median length of hospital stay was 3.5(2.0–6.0)days. Patients were asked “Please indicate on this scale [VAS 0–10] the pain that you currently experience from your incisional hernia during activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively. At one year, 7(11%) patients had experienced hernia recurrence and 33(52%) post-operative seroma. Conclusions Target recruitment was not possible owing to COVID-19. The Manchester Technique has comparable recurrence rates. Reported pain increases post-operatively but is reduced at post-operative day30 and day365.

Para-esophageal hernia repairs are challenging procedures and there is no consensus on the optimal approach to repair. Mesh reinforcement has been associated with lesser hernia recurrence when compared to the primary suture repair. The type of mesh that is most appropriate is still debatable. Synthetic and biosynthetic materials have been studied in the literature. It is well documented that a synthetic mesh is associated with esophageal erosion and migration into the stomach. Though there are limited long-term data on biosynthetic mesh, the short-term results are excellent and promising. This paper illustrates how a biosynthetic prosthesis can be safely used with fibrin glue fixation and anterior Dor fundoplication to repair any para-esophageal defect. The absorbable biosynthetic mesh has been shown to produce good long-term patient satisfaction outcomes and low recurrence rates compared to conventional methods including repair with synthetic mesh. This technique also avoids the risk of esophageal erosion whilst strengthening the repair. Tacks that are still widely used to secure the mesh can be abandoned due to the associated risk of developing cardiac tamponade, or other disastrous consequences. This repair method, also, highlights how the prosthesis can be fashioned into a V-shape and easily placed in an onlay fashion behind the esophagus. The protocol demonstrates an alternative and safer method for mesh fixation using fibrin glue.

Background The advent of mesh was a breakthrough in the field of hernia surgery. Mechanical methods of mesh fixation are hypothesized to cause more tissue trauma than nonmechanical methods. The present study was conducted to study the outcomes of mesh fixation using fibrin glue, a nonmechanical method versus tackers in totally extraperitoneal repair (TEP) of unilateral inguinal hernia. Methods A randomized controlled single blinded study was conducted in India from June 2017 to March 2019. Patients diagnosed with unilateral uncomplicated inguinal hernia with a hernial sac of size not more than 5 cm were invited to participate in the study. Sample size was 60 patients randomized into groups just before mesh fixation. In group A mesh was fixed using tackers while in group B mesh was fixed using fibrin glue. Patients were followed-up prospectively for 3 months. Results There was no statistical difference between the two groups with respect to operating time. Average hospital stay and pain scores at all follow-ups were better for fibrin glue group. There was no difference in the incidence of postoperative urinary retention, seroma formation and hematoma formation between the two groups. Patients of fibrin glue group had early restart of daily activities at 15 days follow-up when compared to tacker group. Conclusion Fibrin glue fixation technique should be advocated over tackers for mesh fixation in TEP considering the better outcomes and cost-effectiveness of the technique.

Introduction Recurrence of inguinal hernia after surgery secondary to mesh fixation techniques still remains a complication of inguinal hernioplasty. This study focuses on evaluating the reflected inguinal ligament and its potential in surgical application. Method A total of 181 patients undergoing inguinal hernia repair at Travancore Medical College, Kollam, Kerala between 2015 to 2020 were included in the study. The reflected inguinal ligament was identified by tracing fibres passing upwards and medially from the pubic tubercle to the rectus sheath. The incidence of the ligament and its shape were documented. Results Of the 181 patients, the male to female ratio was 7.6:1. The average age of the study population was 55.1 ± 14.3. 37% had right sided inguinal hernia, 19% had left sided inguinal hernia and 44% had bilateral inguinal hernia. Intraoperatively, the reflected inguinal ligament was identified in all patients with 60% having a triangular shape and rest had rectangular shape. Rectangular shape is more common as age increases. Discussion Current literature rarely examines the reflected inguinal ligament in depth. Further ambiguity is caused by various authors using different nomenclature for the ligament. Accepting the limitations such as constrained geographical variation in our study population, the findings of our study in combination with those of existing literature warrants further studies specifically evaluating the reflected inguinal ligament. Conclusion The reflected ligament was identified in all of our patients. This study recommends that further studies evaluate the reflected inguinal ligament as a potential landmark to fix the medial end of the mesh during inguinal hernioplasty.

Introduction: A hernia is the protrusion of a viscus or part of a viscus lined by a sac through a normal or abnormal opening in the abdominal wall. Hernias are classified into 2 types based on their visibility, i.e., External hernias and internal hernias. Aim of this study is to Compare mesh fixation versus non-fixation in TAPP (Trans Abdominal Pre Peritoneal Meshplasty) in inguinal hernia. Methodology: Hospital based non randomized prospective case control study. The study was carried out for One year and six months from January 2019 to June 2020. The present study evaluated 40 patients, who admitted with inguinal hernia and undergone TAPP in the Department of General Surgery, RVM Hospital, Siddipet district, Telangana State. Results: Total number of patients observed in the study was 40. Among this 40, 20 patients underwent mesh fixation LIHR and 20 patients underwent non-fixation LIHR. Using Fisher exact test, p value

Background: Hernia is the “Protrusion of the viscous or a part of the viscous through an abnormal opening in the walls of its containing cavity [1]. Lichtenstein tension free mesh repair is the most commonly performed operation by a general surgeon. Postoperative pain can be due to multiple reasons like irritation from the suture used to fix the mesh, by the mesh itself, nerve entrapment etc. This study is used to compare the effectiveness of Cyanoacrylate glue in the fixation of mesh in elective inguinal hernia repair compared to conventional mesh fixation by sutures in terms of duration of surgery,post operative pain and analgesia requirement and return to normal activity. Objectives: The primary objective of this study is to compare the postoperative pain score and analgesia requirement in patients who underwent Lichtenstein tension free hernia repair with cyanoacrylate glue versus conventional surgery using polypropylene sutures. Secondary objective is to compare the duration of surgery and the time taken for return to normal activity.Methodology: This study was conducted between October 2017 and September 2019 and included 50 patients who were randomly assigned into two groups of 25 patients each,glue group and suture group respectively.All cases were followed up for a period of 3 months. Results: In our study, patients who underwent Lichtenstein tension free mesh repair using cyanoacrylate glue had reduced postoperative pain score and required less analgesia compared to conventional suture repair with reduced time taken for surgery and a early return to normal activity.Conclusion: This study concludes that cyanoacrylate glue is an effective alternate to conventional sutures for mesh fixation in Lichtenstein tension free hernia repair as the postoperative complications: Pain and analgesia requirement with an early return to normal activity.

Introduction The use of implants in inguinal hernia repair has reduced its recurrence rate. However, postoperative groin pain still remains an unresolved problem. There are suggestions that in totally extraperitoneal inguinal hernia repair (TEP-IHR) two of the likely factors responsible for pain are use of fixation and the type of fixation used. Aim To evaluate the impact of mesh fixation on the incidence of postoperative pain, restriction of physical activities, hernia recurrence risk, return to normal activities and demand for analgesics in patients after unilateral TEP-IHR. Material and methods Unilateral TEP-IHR was performed in 139 male patients randomized to three groups: self-gripping mesh (SG), lightweight mesh (L) and lightweight mesh with fixation (LF). Full study-inclusion criteria were met by 110 patients; 43, 18 and 49 in groups SG, L and LF respectively. Follow-up occurred on the 1st, 2nd, and 7th day and 3, 6, 12 months postoperatively. The numeric rating scale (NRS) was used to assess pain and the EuraHS-QoL (European Registry for Abdominal Wall Hernias Quality of Life Score) questionnaire to compare quality of life (QoL) prior to surgery and one year later. Results No statistically significant differences were observed between study groups with regard to the incidence rate and intensity of acute post-operative pain, chronic pain, analgesic demand, return to normal activity, hernia recurrence rate and post-operative QoL. Conclusions Lack of fixation in TEP-IHR does not increase the risk of hernia recurrence, and its presence does not significantly worsen the treatment results; especially it does not increase the incidence of chronic pain.

OBJECTIVE The aim of the study is to compare the mesh implantation and the strength of the mesh fixation to the anterior abdominal wall by modelling the intraperitoneal onlay mesh repair (IPOM) with and without aponeurotic defect closure. PATIENTS AND METHODS Materials and methods: The experimental animals were randomly divided into 2 groups of 6 rabbits. In experimental group IPOM was modelled without hernia defect closure, in control group - with its suturing. The macroscopic assessment of the severity of adhesions, histological examination of the removed "anterior abdominal wall - mesh" complex and strength of the mesh fixation to the anterior abdominal wall were performed on the 90th day. RESULTS Results: In both groups, the displacement or complete separation of the mesh from the parietal peritoneum was not observed. The extent of adhesion formation in the abdominal cavity and strength of the mesh fixation are comparable in both groups (p > 0.05). In the experimental group, the mesh was surrounded by scar tissue, mesothelioma lining was not traced. There were also moderate signs of inflammation, which were not seen in the control group. CONCLUSION Conclusions: The strength of the mesh fixation to the parietal peritoneum and its implantation into the anterior abdominal wall is comparable with or without aponeurotic defect closure during the experimental modelling of IPOM.

Summary: Background/objective: Our study aims to compare clinical outcomes of laparoscopic Totally Extra-peritoneal (TEP) repair with mesh fixation in large inguinal hernias using titanium versus absorbable tacks. Methods: This is a case control study of patients who underwent laparoscopic TEP repair with mesh fixation of large inguinal hernias in our institution from 2010 to 2015. In all patients a standard 10 × 15 cm large-pore polypropylene mesh was used and a standardized fixation technique was followed. Patient demographics, presentation, defect size as per the European Hernia Society Groin Hernia Classification, post-operative complications and recurrence rates were collected and analysed. Results: 20 patients had mesh fixation with titanium tackers (Group TT) were compared with 37 patients who had mesh fixation with absorbable tacks (Group AT). Mean age was 57.00 (±13.78) in Group TT and 49.00 (±17.15) in Group AT. All patients were males. The median defect size was L3M2 in Group TT and L2M2 in Group AT. All patients were followed up for a mean period of 24 months (range: 1–48 months). Post-operatively, one patient in Group AT developed chronic pain. One Group TT patient and four Group AT patients developed seromas, which were treated conservatively. There were no recurrences in Group TT, while one Group AT patient developed a medial recurrence. Conclusion: Both titanium and absorbable tacks showed similar post-operative complications and pain scores. As such, they both appear safe and feasible for mesh fixation during laparoscopic repair of large inguinal hernias. Keywords: Absorbable fixation, Inguinal hernia, Mesh fixation, TEP repair

Introduction. This article presents a new mesh fixation technique for “onlay hernia repair”, based on a new principle – the “Equally-Distributed-Tension Principle”. Methods. The fixation technique is based on a continuous suture, different from any other continuous suture, with no stiffened points of attachment. It allows a slight glide of the thread, making possible the equally-distribution of tension. Based on this technique it is possible to realize a mesh fixation under tension. The „tension-free” concept is not suitable for ventral hernias. The mesh should be sutured under tension – the only way to remove the tension from the midline suture and offer the posibility for the aponeurotic layer to heal and regain its strenght. A new fixation system is necessary, a more efficient one, that will sustain this tension, without failure. In the same time, this system is the only one capable to realize an uniform distribution of tension. Results. Between February 2016 and November 2018, 49 patients were treated by this method in the Ilfov County Emergency Hospital, Bucharest, Romania, with only one recurrence until now (a bridging technique was used in this case). Conclusions. The new suture system is very easy to apply, very fast, extremely reliable and offers the posibility to manage a large variety of ventral hernias.

Laparoscopic ventral and incisional hernia repair (LVIHR) has become a common procedure because of its feasibility and safety, but it is not free of complications. Acute and chronic post-operative pain and bleeding caused by traumatic fixation of the mesh are frequently prolonging the hospital stay. The aim of this study was to analyze the behavior of n-butyl-cyanoacrylate (GLUBRAN® 2) as only mesh fixation Ten female pigs were involved in the study and were divided into two groups of five (A and B). Animals in each group underwent a laparoscopic procedure in which two meshes were placed intraperitoneally and fixed with the same synthetic glue only. Animals in group A were sacrificed after 3 weeks, and those in group B were sacrificed after 12 weeks. We studied the morphological, biomechanical, and histological characteristics of the intraperitoneal mesh–tissue interface No disruption, migration or folding was observed in any of the pigs. In group A, the mean tensile strength was 1.4 N/cm (± 0.2) while in group B, the mean tensile strength was 2.5 N/cm (± 0.8). Histological analyses, in areas where mesh was fixed using the glue, showed a chronic lymphocytic inflammatory reaction with a granulomatous component and a marked desmoplastic reaction made up of immature collagen and numerous fibroblasts acquiring myofibroblastic characteristics. In some areas corresponding to fixation, the desmoplastic reaction originated from mature lamellar bone tissue with osteocytes and osteoblasts. Laparoscopic mesh fixation with only the synthetic comonomer glue GLUBRAN® 2 is feasible, effective, and safe in intraperitoneal incisional/ventral hernia repair in this animal model.

Prosthetic inguinal hernia repair presents significant challenges. Some of these, such as mesh fixation and quality of the biologic response, are still debated among surgeons. For example, there is no strong consensus regarding a specific condition that characterizes the surgical procedure during herniorrhaphy. This issue concerns management of the hernia defect, which in conventional hernia repair with flat meshes remains patent. However, a critical analysis of typical postoperative complications after inguinal hernia repair reveals that some of these adverse events are related to patency of the hernial opening. Postoperative discomfort, pain with specific movements and even hernia recurrence can be caused by incomplete or defective management of the hernia defect. For this reason, a deeper understanding of this topic would be useful for improving postoperative outcomes. A recently updated concept for inguinal hernia repair takes this technical aspect into consideration. It is based on the use of a newly developed 3D scaffold—ProFlor™ (Insightra Medical, Inc., Clarksville, TN, USA)—that is intended to be deployed into the defect. This novel hernia repair device has interesting and original features, such as dynamic responsivity in compliance with inguinal movement, fixation-free mode and regenerative behavior that counteracts the degenerative effects of the disease. Another additional proprietary feature of this 3D scaffold is the full and permanent obliteration of the defect, which is a crucial aspect to improve outcomes by avoiding the typical adverse effects of this surgical procedure. Obliteration of the hernia defect with the 3D dynamic regenerative scaffold ProFlor™ appears to be superior to coverage by means of static (passive) flat meshes/plugs used in conventional hernia repair. This report highlights the principles of this procedural approach.

Inguinal hernia repair is one of the most common general surgical operations performed worldwide. More than a million inguinal hernia repairs are performed annually in the United States...

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Background The current standard for open and laparoscopic repair of incisional hernia consist of an abdominal wall augmentation by mesh implantation. However, the ideal fixation method of the prothesis material remains under discussion, due to potential complications of conventional fixation methods such as chronic abdominal pain or intestinal obstruction. As the use of adhesive based mesh fixation is an option of growing interest, the aim of this experimental study was to investigate the strength and biocompatibility of two newly developed polyurethane-based adhesives in comparison to a cyanoacrylatic adhesive, which is currently in clinical use. Methods Two experimental polyurethane/urea-based adhesives (Adhesive-A and Adhesive-B) were compared to a conventional cyanoacrylatic adhesive and an untreated control group. Biomechanical testing was carried out using a pull-out test in uniaxial tensile mode, while biocompatibility assessment was performed in a rat model with 40 Sprague-Dawley rats receiving a subcutaneous implanted PVDF mesh fixed by the corresponding adhesive. Histological and immunohistochemical analysis by a Tissue FAXS system examined the tissue integration of the mesh/adhesive combination and characterized the foreign body reaction. Results Biomechanical testing of the mesh/adhesive combinations showed a minimal strength of 15.08 N without a significant difference between the groups. Cellular penetration into the mesh/adhesive interface was significantly improved after application of polyurethane adhesives and Adhesive-A showed a significantly lower migration of CD68 positive cells to the adhesive sites compared to cyanoacrylate after 7 days. Conclusion The developed polyurethane-based adhesives are a promising alternative with sufficient adhesive strength and superior short-term biocompatibility to cyanoacrylate.

Objective The incidence and associated risk factors for sacral osteomyelitis and sacral discitis after sacrocolpopexy remain unknown. The aim of this study was to determine the incidence of sacral osteomyelitis and discitis after minimally invasive sacrocolpopexy and their association with the method of sacral mesh fixation. Methods This is a retrospective cohort study of consecutive minimally invasive sacrocolpopexies performed by 11 female pelvic medicine and reconstructive surgery board-certified surgeons from January 2009 to August 2019 within a single health system. Sociodemographic, procedure, and clinical variables were abstracted from the electronic health record (EHR). We then performed a confirmatory EHR interrogation, cross-referencing procedural codes for laparoscopic and robot-assisted sacrocolpopexy and diagnostic codes for sacral osteomyelitis and sacral discitis. Results The EHR chart review identified 1,189 women who underwent laparoscopic (55.2%) and robot-assisted (44.8%) minimally invasive sacrocolpopexy, all with polypropylene mesh. Median follow-up was 7.7 months (interquartile range, 0-49.8). Titanium helical tacks were used in 52.7% patients, sutures in 41.6%, and both in 5.6%. No cases (0%) of sacral osteomyelitis or discitis were identified by chart review. The system-wide EHR interrogation of procedural and diagnostic codes identified 421 additional procedures for a total of 1,610 minimally invasive sacrocolpopexies. Among these, there were no cases (0%) of osteomyelitis or discitis. Conclusions Sacral osteomyelitis and discitis are rare early outcomes after minimally invasive sacrocolpopexy with an incidence of less than 1/1,000 cases. Given an absence of cases, we were unable to assess for an association between method of sacral attachment and sacral osteomyelitis and sacral discitis.

Background Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. Methods A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications. Results Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025). Conclusions At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.

Hernias of the lateral abdominal wall are a rare entity. In most cases, they occur after surgery or trauma. We present two cases of lumbar hernia: the first one after iliac bone grafting and the second one after muscular tearing by the seatbelt during a car accident. Both cases were successfully repaired using a propylene mesh with bone fixation.Las eventraciones de la pared lateral del abdomen son poco frecuentes. Pueden ser posquirúrgicas o causadas por agentes traumáticos. Se presentan dos casos de eventración lumbar: el primero tras una resección ósea por autoinjerto de cresta ilíaca y el segundo por desinserción muscular por cinturón de seguridad secundaria a un accidente en la vía pública. Ambos fueron resueltos quirúrgicamente con colocación de una malla de polipropileno fijada a hueso.

Ventral hernias have numerous etiologies ranging from sequelae of surgical procedures to congenital deformities. Patients suffering from these hernias experience a reduced quality of life through pain, associated complications, and physical disfigurement. Therefore, it is important to provide these patients with a steadfast repair that restores functionality and native anatomy. In order to do this, techniques and materials for abdominal wall reconstruction have advanced throughout the decades leading to durable surgical repairs. At the cornerstone of this lies the use of mesh.When providing abdominal wall reconstruction, a surgeon must make many decisions with regards to mesh usage. Along with the type of mesh and plane of placement of mesh, a surgeon must decide on the method of mesh fixation. Fixation of mesh provides an equal distribution of tension and a more robust tissue-mesh interface, which promotes integration. There exist numerous modalities for mesh fixation, each with its own benefits and drawbacks. This Special Topic article aims to compare and contrast methods of mesh fixation in terms of strength of fixation, clinical outcomes, and cost-effectiveness. Methods included in this review are suture, tack, fibrin glue, mesh strip, and self-adhering modes of fixation.

Background: Vaginal surgery was the traditional way to manage uterovaginal prolapse. However, it has a high rate of recurrence. Aims: this study aimed to compare the outcomes of abdominal hysterectomy and sacrocolpopexy using short and long vaginal mesh arms in women with uterovaginal prolapse. Patients and Methods: We conducted a retrospective cohort study of women with uterovaginal prolapse. The study included 185 patients. The patients were divided into two groups. Each patient underwent abdominal hysterectomy and sacrocolpopexy. Sacrocolpopexy was done using a Y-shaped polypropylene mesh. The posterior arm was fixed to the posterior vaginal wall down to the level of the levator ani. The anterior arm was fixed to the anterior vaginal wall to a variable distance of 2 to 3 cm in the short arms group or down to the trigone in the long arms group. Results: The use of long arms mesh was associated with significantly lower rate of recurrence. Eighty percent of recurrence occurs in the short arm group. In comparison, 20% of recurrence occurs in the long arm group. There was no repeat surgery in the long arms group compared with 4% in the short arms group. Conclusion: In women with uterovaginal prolapse, abdominal hysterectomy and sacrocolpopexy using long vaginal mesh arms appears to result in a lower rate of recurrence compared to abdominal hysterectomy and sacrocolpopexy using short vaginal mesh arms.

In an effort to optimize the results during inguinal hernia repair, surgeons need to consider the role of different mesh fixation techniques. The use of tissue adhesives is proposed for mesh fixation, which demonstrate similar or improved outcomes in the realm of postoperative pain, hernia recurrence, cost, and formation of a hematoma or seroma. In this review, mesh fixation using fibrin glue and cyanoacrylate glue is compared to standard suture or tack techniques. The results of this investigation warrant consideration by surgeons seeking to improve patient outcomes.