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Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice. Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p values inferior to 0.10 and I2 > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing). Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I2 = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I2 = 84%). The use of tacks was associated with shorter operative time (MD—25.80 [min]; 95% − 34.31– − 17.28; P < 0.00001; I2 = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates. Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week. [ABSTRACT FROM AUTHOR]

Aim: This study has compared the postoperative pain, scrotal edema, seroma, bleeding or other complications between two patient groups getting laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy and where absorbable and non-absorbable fixations (3/0 prolene suture) were used in mesh fixation compared with such complications as hematoma, urinary retention, and recurrence. Materials and Methods: 44 male patients getting laparoscopic TAPP herniorrhaphy method were included in this study. According to the material used for mesh fixation, they were divided into two groups getting absorbable or non-absorbable fixations. The age, gender, hernia type and direction according to the Nyhus Classification, and the fixation material used intraoperatively were all recorded for patients. 1st week, 1st month and 6th month postoperative checks were made. Early complications at the postoperative period were compared between groups. Patients gave written and informed consent before surgery. Results: Of the 44 patients, absorbable fixation devices were placed in 27 and nonabsorbable ones in 17. At the 1st week follow-up, scrotal edema was diagnosticated in 3 patients in the absorbable group and in 2 in the non-absorbable; seroma in 5 patients in the absorbable group and in 2 in the non-absorbable; mild pain in 3 patients in the absorbable group and in 5 in the non-absorbable. A significant relationship was not statistiscally found between the presence or absence of scrotal edema, or of seroma, pain intensity and the fixation material used (p>0.05). Conclusion: A significant difference was not found when early complications were statistically compared between the patients getting laparoscopic TAPP herniorrhaphy and having used absorbable and non-absorbable fixation devices. It seems both fixation materials can be used safely. [ABSTRACT FROM AUTHOR]

Background: Several methods are used for mesh fixation in laparoscopic hernia repair including staples, tackers, sutures, and polycyanoacrylate derivatives. Objective: This study aimed to compare the outcomes of fixation versus non fixation of the mesh in laparoscopic trans-abdominal preperitoneal repair (TAPP). Patients and methods: The current study include 64 male patients who were eligible for TAPP repair. They were divided into two groups: Group A (n =32) underwent TAPP with mesh fixation, while group B (n=32) underwent TAPP without mesh fixation. Follow up was done for Operative time and times to ambulation, return to daily activity, long-term follow up for recurrence and postoperative pain. Results: The mean age was 42.7 ± 4.5 and 44.2 ± 3.9 years in groups A and B respectively. There was significantly less mean operative time in group B than in group A. There was no statistically significant difference regarding early post-operative pain in both groups. The reported time for return to basic, home and work activities were almost the same with no reported significant difference. For long-term follow up there was statistically significant less chronic pain and FB sensation in group B. There was no reported recurrence, or testicular atrophy in both groups. Conclusion: According to the current results, TAPP repair can be done without significant impact on the outcomes. [ABSTRACT FROM AUTHOR]

Objective: Many studies have shown that non-fixation of mesh in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation; however, most studies contain limited information on hernia-defect size. The purpose of this study was to compare the clinical outcome of nonfixation and fixation of mesh in consecutive elective laparoscopic TEP inguinal hernia repair in any type and size of hernia defect classified by the European Hernia Society (EHS) groin hernia classification to be a part of the level 1 evidence about technique of fixation in TEP. Patients and Methods: One hundred and ten hernia repairs in 101 patients were enrolled in the trial between July 2022 and August 2023. The patients were randomized to the mesh fixation group (n = 55) or the non-fixation group (n = 55). The primary outcomes were chronic groin pain and recurrence at 6 months. The secondary outcomes were operative time, conversion rates, pain scores, analgesic requirement, time to regular activity, complications, and length of stay. A person blinded to the method of fixation performed statistical analysis. Results: There were no significant differences between the two groups in baseline demographic characteristics, including age, BMI, sex, ASA classification, EHS hernia classification, and incidence of recurrent defect. More than 90% of hernia defects were larger than 1.5 cm, and more than 25% of defects were > 3 cm. They were statistically similar in both groups in terms of chronic groin pain, operative time, conversion rates, pain scores, analgesic requirement, time to regular activity, length of stay, and complications. Neither group had a recurrence at a minimum follow-up of 6 months. Conclusions: There was no statistical significance in chronic groin pain and recurrence between fixation and non-fixation groups. The non-fixation approach should be adopted routinely and safely in laparoscopic TEP hernia repair. Even the tack fixation technique applied in this study was not associated with the risk of significant pain level and chronic groin pain; however, it is associated with high operative cost, so it should be used only in very selected situations in TEP. [ABSTRACT FROM AUTHOR]

Introduction: Sutures or tacks are commonly used to secure a mesh in intraperitoneal onlay mesh (IPOM) hernia repair, but such penetrating fixations can cause local damage, that can be associated with pain. The use of an adhesive could be an alternative to reduce complications. However, a risk associated with this approach has been identified, particularly when the defect cannot be closed. A mesh glued to the peritoneum only might not provide as much mechanical reinforcement to the abdominal wall (AW) as a mesh anchored to the myofascial structure with penetrating fixations, which could lead to an increased recurrence rate. Additionally, the high elasticity of the peritoneum may increase mesh bulging. Leveraging an ex vivo approach, the objective of this study was to investigate the impact of mesh fixation using glue versus barbed sutures, on its biomechanical response for IPOM surgery. Methods: An experimental method was developed using ex vivo porcine abdominal wall samples (n = 12). A 4-cm centered circular defect was created by dissecting the skin and the subcutaneous tissue and removing muscle and extraperitoneal fat, while keeping the peritoneum intact. A 14-cm diameter mesh was secured (Dermabond™ cyanoacrylate adhesive or V-Loc™ barbed sutures) to the AW. The mesh was placed on the peritoneum to remain consistent with the IPOM placement. The sample was then subjected to some inflation tests to simulate increased levels of intra-abdominal pressure (IAP) representing daily activities. For each test, mesh bulging into the defect was assessed as a function of the pressure using Digital Image Correlation (DIC) analysis. Results: Mesh bulging was studied for 2 configurations: suture fixation and glue. Glued meshes exhibited significantly higher bulging values than when sutured with a significant difference (p = 0.013) observed at 252 mmHg and a certain trend for statistical difference (p < 0.1) for stair climbing or coughing activities. Additionally, the stiffness of the repair was also significantly higher when the mesh was sutured compared to when it was glued to the peritoneum (p < 0.05). Conclusion: This study demonstrated that a mesh glued to the peritoneum exhibited higher bulging and a behavior of the repair less stiff compared to when it was sutured to the myofascial structure of the AW, particularly for high intra-abdominal pressures. However, the impact of these differences remains to be evaluated over time. Further preclinical investigations are needed to quantify their impact post-operatively. [ABSTRACT FROM AUTHOR]

Background: The mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field. Methods: We designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021. Results: The evaluated patients’ median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences. Conclusions: Self-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

Aim: Laparoscopic inguinal hernia surgery is performed in many centers today. Mesh fixation is an important step in this procedure. In this study, we aim to show our results in total extraperitoneal repair of inguinal hernias using absorbable tuckers and n-butyl cyanoacrylate glue for mesh fixation. Materials and Methods: All surgeries were performed by a single surgeon. The surgeries were performed in Private Erdem Hospital İstanbul and Al Zahra Hospital Dubai between January 2015 and February 2022. Mesh fixation of the patients was applied in a randomized manner using absorbable tucker and glue. The patients were compared in terms of postoperative visual pain score (VAS), opioid need, length of hospital stay, duration of surgery, presence of recurrence and chronic pain. Results: A total of 226 patients were operated. Absorbable tucker were used for mesh fixation in 138 patients, and glue was used in 88 patients. The age and gender distribution of the patients were similar in both groups. No patient had any major complications or mortality during or after surgery. There was no conversion to open surgery. Operation time was similar in both groups. In the glue group, VAS was found to be significantly lower at the 8th hour after surgery. There was also a significant reduction in opioid requirement in the same group. The same-day discharge rate in the glue group was statistically significantly higher than in the absorbable tucker group. All patients were followed up for at least six months. Recurrence was observed in two patients (one patient in each group). The number of patients with chronic pain was significantly higher in the absorbable stapler group than in the other group. Conclusion: The use of glue for mesh fixation in laparoscopic extraperitoneal inguinal hernia repair is a safe method. Fixation with glue is clearly advantageous comparing to absorbable tuckers in terms of postoperative pain, early discharge, and chronic pain.

Background: Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial. Methods: The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software. Results: Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09). Conclusion: Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.

It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P

Background: Abdominal hernia repair surgeries involve the fixation of a surgical mesh to the abdominal wall with different means such as suture, tacks, and glues. Currently, the most effective mesh fixation system is still debated. This review compares outcomes of mesh fixation in different surgical procedures, aiding surgeons in identifying the optimal technique. Methods: A meta-analysis was conducted according to PRISMA guidelines. Articles published between January 2003 and January 2023 were searched in electronic databases. Randomized controlled trials (RCTs) comparing mesh fixation with cyanoacrylate-based or fibrin glues with classical fixation techniques (sutures, tacks) in open and laparoscopic procedures were included. Results: 17 RCTs were identified; the cumulative study population included 3919 patients and a total of 3976 inguinal hernias. Cyanoacrylate-based and fibrin glues were used in 1639 different defects, suture and tacks in 1912 defects, self-gripping mesh in 404 cases, and no mesh fixation in 21 defects. Glue fixation resulted in lower early postoperative pain, and chronic pain occurred less frequently. The incidence of hematoma was lower with glue fixation than with mechanical fixation. Recurrence rate, seroma formation, operative and hospitalization time showed no significant differences; but significantly, a higher number of people in the glue group returned to work by 15- and 30-days after surgery when compared to the tacker and suture groups in the same time frame. Conclusion: Cyanoacrylate and fibrin glue may be effective in reducing early and chronic pain and hematoma incidence without increasing the recurrence rate, the seroma formation, or the operative and hospitalization time.

Introduction: “Laparoscopic Total Extraperitoneal (TEP)” repair of hernia is a common surgical procedure for treating groin hernias. This study focused on the long-standing assessment of “quality of life (QoL),” chronic pain, and recurrence to compare the effectiveness of TEP hernia surgery with “mesh fixation (MF)” against “nonfixation (NF)” in patients who are obese with a BMI of 35 kgs/m2 or higher. Methods: In this study's randomized controlled experiment, 73 obese individuals with groin hernias underwent total extraperitoneal hernia repair with either MF (n = 35) or NF (n = 38). A check-up was conducted 1, 3, and 5 years after the operation. Recurrence, chronic pain, and QoL were assessed using a physical examination and validated questionnaires. Results: There were no changes between the subjects of either group in baseline characteristics, hernia recurrence rate, chronic pain rate, or QoL. There were neither significant variations in surgical complications nor hospital stay duration. Conclusion: The results suggest that treating TEP hernias among people with a BMI of 35 kgs/m2 or above with mesh NF may be successful. The recurrence rates among the subject groups were not substantially different; however, NF was linked with reduced rates of chronic pain which would be beneficial for patient satisfaction and recovery. To decide the optimal technique for MF in TEP hernia repair, these findings need to be verified by additional studies.

Background: It remains controversial whether mesh should be fixed during laparoscopic inguinal hernia repair. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare fixation and nonfixation in laparoscopic groin hernia repair. Methods: A registration was listed with PROSPERO (International Prospective Register of Systematic Reviews; registration no. CRD42022350469). Databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched to identify RCTs comparing fixation with nonfixation in laparoscopic groin hernia repair. The primary outcomes were postoperative pain at 24 hours and recurrence. Secondary outcomes were mean operative time, urinary retention, and postoperative pain at 6 months. Results: A total of 18 trials, including 2617 patients with 2878 hernias, were included in this meta-analysis. In contrast to the fixation group, the nonfixation group was associated with lower postoperative pain scores at 24 hours and 6 months, a shorter mean operative time, and a lower incidence of urinary retention. There were no significant differences between the 2 types of procedures in terms of the rate of recurrence for patients with an inguinal hernia orifice smaller than 4 cm in size. Conclusions: The nonfixation technique is an effective method to reduce urinary retention, mean operative time, and postoperative pain at 24 hours and at 6 months; however, the rate of recurrence was comparable to that of the fixation method. [ABSTRACT FROM AUTHOR]

Background: In laparoscopic ventral hernia repair (LVHR) there are many modifications related to the methods of mesh fixation. Using trans-fascial sutures decrease the chance of mesh shrinkage and migration and subsequent hernia recurrence but it is still controversial in comparison with tackers alone. Objective: The study goal was to assess the effect of adding four corners trans-fascial sutures to double crown tackers for mesh fixation. Patients and Methods: A total of 50 patients with different types of abdominal wall hernias were subjected to LVHR. Patients were randomized into two groups: Group A where mesh was fixed using double crown of tackers only and group B where mesh was fixed using both tackers and four corners trans-fascial sutures. Mesh fixation duration, postoperative pain score and recurrence rate were recorded. Results: Males and females were 21 and 29, respectively. The mean age was 48 years. Types of hernias were 29 para umbilical hernias (PUH), 17 incisional hernias and 4 epigastric hernias. In Group A, the median operative time for mesh fixation was 15 mins. In group B, the duration was 24 minutes. The median Visual Analogue Scale (VAS) for pain was 1 at 24 hours post-operative. The average hospital stay post-surgery was between 1 to 3 days. Within 12 months, three patients from group A experienced a recurrence of their hernia. Conclusions: LVHR with tackers was an easy and time saving procedure. However, adding trans-fascial sutures decreased the chance of mesh shrinkage/migration and gave less recurrence rate. [ABSTRACT FROM AUTHOR]

Purpose: To examine updated evidence on the efficacy and safety of mesh non-fixation in patients undergoing laparo-endoscopic repair of groin hernias. Methods: We searched MEDLINE, Cochrane Central Library, Embase, ClinicalTrials. gov, and ICTRP databases to identify randomized controlled trials. The primary outcomes were recurrence, chronic pain, and return to daily life. The certainty of evidence (CoE) was assessed by grading recommendations, assessments, developments, and evaluations. We performed a subgroup analysis based on the surgical type. This study was registered with PROSPERO (CRD 42022368929). Results: We included 25 trials with 3,668 patients (4,038 hernias) were included. Mesh non-fixation resulted in little to no difference in hernia recurrence (relative risk [RR]:1.40, 95% confidence interval [CI]:0.59–3.31; I2 = 0%; moderate CoE) and chronic pain (RR:0.48, 95% CI:0.13–1.78; I2 = 77%; moderate CoE), but reduced return to daily life (mean difference [MD]: − 1.79 days, 95% CI: − 2.79 to –0.80; I2 = 96%; low CoE). In subgroup analyses, the transabdominal preperitoneal approach (TAPP) (MD: − 2.97 days, 95% CI: − 4.87 to − 1.08; I2 = 97%) reduced return to daily life than total extraperitoneal inguinal approach (MD: − 0.24 days, 95% CI − 0.71 to 0.24; I2 = 61%) (p = 0.006). Conclusions: Mesh nonfixation improves the return to daily life without increasing the risk of hernia recurrence or chronic pain. Surgeons and patients may discuss mesh nonfixation options to accommodate a patient's desired return to daily life. Further trials focusing on TAPP are required to confirm these findings. [ABSTRACT FROM AUTHOR]

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Background: Regarding the need for mesh fixation in total extraperitoneal inguinal hernia repair (TEP), several studies have found no significant differences in the recurrence rate between patients with and without fixation. Furthermore, there is no report on the outcome of this treatment from Japan. We aimed to analyze the outcomes of nonfixation TEP with those of fixation at our institute. Methods: In May 2016, the nonfixation TEP technique was launched. The fixation group (165 patients) was compared to the nonfixation group (195 patients). Because of the significant bias between the two groups, a propensity score matched analysis was performed (with 109 patients in each group). Moreover, only ordinary cases (with 58 patients in each group) were compared, excluding bilateral, large, and impaction cases. Results: One patient in the nonfixation group experienced recurrence. It was a hernia case with a large orifice. In the fixation group, seroma was more prevalent; however, no differences were observed between the two groups in propensity score matching. In unilateral cases, the nonfixation group had a shorter operation time and stayed in the hospital for a shorter time postoperatively. The ordinary cases, excluding cases of bilateral hernias, large hernias on visual examination, impactions, and large hernial orifices, showed no recurrence or significance in surgical complications. Conclusions: The nonfixation TEP was considered acceptable at least for ordinary hernial cases.

Introduction: "Laparoscopic Total Extraperitoneal (TEP)" repair of hernia is a common surgical procedure for treating groin hernias. This study focused on the long-standing assessment of "quality of life (QoL)," chronic pain, and recurrence to compare the effectiveness of TEP hernia surgery with "mesh fixation (MF)" against "nonfixation (NF)" in patients who are obese with a BMI of 35 kgs/m2 or higher. Methods: In this study's randomized controlled experiment, 73 obese individuals with groin hernias underwent total extraperitoneal hernia repair with either MF (n = 35) or NF (n = 38). A check-up was conducted 1, 3, and 5 years after the operation. Recurrence, chronic pain, and QoL were assessed using a physical examination and validated questionnaires. Results: There were no changes between the subjects of either group in baseline characteristics, hernia recurrence rate, chronic pain rate, or QoL. There were neither significant variations in surgical complications nor hospital stay duration. Conclusion: The results suggest that treating TEP hernias among people with a BMI of 35 kgs/m2 or above with mesh NF may be successful. The recurrence rates among the subject groups were not substantially different; however, NF was linked with reduced rates of chronic pain which would be beneficial for patient satisfaction and recovery. To decide the optimal technique for MF in TEP hernia repair, these findings need to be verified by additional studies. [ABSTRACT FROM AUTHOR]

Objective: To compare laparoscopic pectopexy with the standard laparoscopic sacropexy in women with symptomatic apical prolapse. Material and Methods: An interim analysis of an exploratory randomized controlled trial with the primary objective of comparing mesh fixation time and secondary objectives were to compare total operating time, blood loss, and intra-operative and post-operative complications. Additionally, patients completed the Prolapse Quality of Life (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) questionnaires before surgery and during six months follow-up visit to evaluate the overall improvement in quality of life and sexual function. Patient Global Impression of Improvement (PGI-I) score was calculated on the 7-10th day post-operatively and then at six months to assess the level of improvement. Results: The study included 30 patients; 15 underwent laparoscopic sacropexy, and 15 underwent laparoscopic pectopexy. Baseline characteristics were comparable in both groups. The mean duration of mesh fixation was significantly less with laparoscopic pectopexy (45.00±11.34 minutes) than laparoscopic sacropexy (54.67±9.35 minutes) (p=0.019). The total operating time and blood loss tended to be less in the pectopexy group, but not significantly so. Only one patient in the pectopexy group had a bladder injury. No patient in either group had any post-operative complications. One case in each group had a relapse of apical prolapse. All the domains of PISQ-12, P-QOL, and PGI-I scores improved significantly after both procedures. Conclusion: Laparoscopic pectopexy is a safe, feasible, and comfortable alternative procedure to the standard sacropexy for apical prolapse. We noted significantly less mesh fixation time and less operating time, while blood loss tended to be less with laparoscopic pectopexy than with laparoscopic sacropexy. Post-operative parameters were comparable between techniques. Both corrective techniques for prolapse improved the PGI-I, P-QOL, and PISQ-12 scores. [ABSTRACT FROM AUTHOR]

It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P < 0.00001], urinary retention[RR = 0.53, 95% CI(0.29,0.97), P = 0.04], haematoma[RR = 0.23, 95% CI(0.09,0.58), P = 0.002] and total complications[RR = 0.28, 95% CI(0.18,0.44), P < 0.00001]; there were no significant differences in pain score on postoperative day 1[MD = −1.33, 95% CI(-2.93,0.26), P = 0.10], operation time[MD = 1.46, 95% CI(-3.97,6.88), P = 0.60] and recurrence rate[RR = 0.72, 95% CI(0.35,1.47), P = 0.37] between the two groups. In conclusion, the application of glue mesh fixation in laparoscopic inguinal hernia repair is safe and reliable with fewer complications. Moreover, it can reduce the incidence of chronic pain without increasing the recurrence rate. However, due to the small number of cases in this analysis and limitations in the quality of the included studies, the findings need to be further verified by multicentre, large-sample and high-quality RCTs in the future. [ABSTRACT FROM AUTHOR]

Regarding the need for mesh fixation in total extraperitoneal inguinal hernia repair (TEP), several studies have found no significant differences in the recurrence rate between patients with and without fixation. Furthermore, there is no report on the outcome of this treatment from Japan. We aimed to analyze the outcomes of nonfixation TEP with those of fixation at our institute. In May 2016, the nonfixation TEP technique was launched. The fixation group (165 patients) was compared to the nonfixation group (195 patients). Because of the significant bias between the two groups, a propensity score matched analysis was performed (with 109 patients in each group). Moreover, only ordinary cases (with 58 patients in each group) were compared, excluding bilateral, large, and impaction cases. One patient in the nonfixation group experienced recurrence. It was a hernia case with a large orifice. In the fixation group, seroma was more prevalent; however, no differences were observed between the two groups in propensity score matching. In unilateral cases, the nonfixation group had a shorter operation time and stayed in the hospital for a shorter time postoperatively. The ordinary cases, excluding cases of bilateral hernias, large hernias on visual examination, impactions, and large hernial orifices, showed no recurrence or significance in surgical complications. The nonfixation TEP was considered acceptable at least for ordinary hernial cases. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study reports economic evaluation of mesh fixation in open and laparoscopic hernia repair from a prospective real-world cohort study, using cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). Methods A prospective real-world cohort study was conducted in two university-based hospitals in Thailand from November 2018 to 2019. Patient data on hernia features, operative approaches, clinical outcomes, associated cost data, and quality of life were collected. Models were used to determine each group’s treatment effect, potential outcome means, and average treatment effects. An incremental cost-effectiveness ratio was used to evaluate the incremental risk of hernia recurrences. Results The 261 patients in this study were divided into six groups: laparoscopic with tack (LT, n = 47), glue (LG, n = 26), and self-gripping mesh (LSG, n = 30), and open with suture (OS, n = 117), glue (OG, n = 18), and self-gripping mesh (OSG, n = 23). Hernia recurrence was most common in LSG. The mean utility score was highest in OG and OSG (both 0.99). Treatment costs were generally higher for laparoscopic than open procedures. The cost-effectiveness plane for utility and hernia recurrence identified LSG as least cost effective. Cost-effectiveness acceptability curves identified OG as having the highest probability of being cost effective at willingness to pay levels between $0 and $3,300, followed by OSG. Conclusion Given the similarity of hernia recurrence among all major procedures, the cost of surgery may impact the decision. According to our findings, open hernia repair with adhesive or self-gripping mesh appears most cost-effective.

Purpose: Treatment of pelvic organ prolapse (POP) often requires the use of synthetic mesh. In case of a novel and standardized bilateral apical fixation, both uterosacral ligaments are replaced by polyvinylidene-fluoride (PVDF) tapes. One of the main problems remains the fixation method, which should be stable, but also simple and quick to use. The current study evaluated biomechanical differences between the cervical tape fixation with sutures (group 1), non-absorbable tacks (group 2) and absorbable tacks (group 3) in an in vitro porcine model. Methods: A total of 28 trials, conducted in three groups, were performed on porcine, fresh cadaver uteri. All trials were performed until mesh, tissue or fixation device failure occurred. Primary endpoints were the biomechanical properties maximum load (N), displacement at failure (mm) and stiffness (N/mm). The failure mode was a secondary endpoint. Results: There was a significant difference between all three groups concerning the maximum load. Group 1 (sutures) supported a maximum load of 64 ± 15 N, group 2 (non-absorbable tacks) yielded 41 ± 10 N and group 3 (absorbable tacks) achieved 15 ± 8 N. The most common failure mode was a mesh failure for group 1 and 2 and a fixation device failure for group 3. Conclusion: The PVDF-tape fixation with sutures supports 1.5 times the load that is supported by non-absorbable tacks and 4.2 times the load that is supported by absorbable tacks. Nevertheless, there was also a stable fixation through tacks. Sutures are the significantly stronger and cheaper fixation device but may prolong the surgical time in contrast to the use of tacks. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the safety and effectiveness of a Chinese absorbable tack for mesh fixation in laparoscopic abdominal wall hernia repair compared to a widely used similar imported product.Methods: From May 2019 to December 2020, the clinical data of 158 patients with abdominal wall hernias were analyzed. They were divided into two groups: 76 patients underwent surgery with local absorbable tacks for mesh fixation (experimental group) and 82 patients received a similar imported product (control group). Preoperative and postoperative variables, effectiveness of postoperative immediate fixation, and with ease of handling of instruments were analyzed statistically. Complications and adverse events were followed and analyzed statistically. Meanwhile, medical costs were recorded and evaluated.Results: There were no statistically significant differences between the two groups in terms of demographic data, hernia types, hernia defects, or number of tacks used for mesh fixation during operation. The effect of postoperative immediate fixation and with ease of handling of instruments in both groups were not significantly different. During the follow-up period, no recurrence or adverse events occurred in either group. No significant differences were noted between the two groups for other complications, such as chronic pain, foreign body sensation, infection of the abdominal wall, hematoma and seroma. There was a significant difference in medical costs between the two groups: the costs associated with the experimental group using local tacks were lower.Conclusion: Chinese absorbable tacks for mesh fixation in laparoscopic abdominal wall hernia repair are effective, safe, and economical. They are worthy of clinical application. [ABSTRACT FROM AUTHOR]

Purpose: Laparoscopic ventral rectopexy (LVR) plus sacral colpopexy (LSC) is a high-complexity surgical procedure. The aim of the present study was to evaluate a new approach to rectal-mesh fixation during LVR with continuous locked suture.Methods: This is a prospective randomized double-blinded clinical trial enrolling 80 patients with severe POP and obstructed defecation syndrome (ODS) from November 2016 to January 2021. Patients underwent a "two-meshes" LSC plus LVR and were randomized, regarding rectal mesh fixation, in Group A (extracorporeal interrupted 0 delayed absorbable sutures) and Group B ("U-shaped" running locked 0 delayed absorbable suture). Our primary endpoints were the operative times (OT); the secondary endpoints were the incidence of anatomical failures, vaginal mesh erosions and surgical complications.Results: A total of 75 patients completed the study. Baseline characteristics were similar between the groups. Overall OT (156 vs 138 min; p < 0.05; treatment reduction of 11.5%) and LVR mesh fixation time (29 vs 16 min; p < 0.05; treatment reduction of 44%), resulted in significantly lower in Group B. No differences were found in terms of anatomic failure, vaginal mesh erosion or intra- or post-operative complications. PGI-I, FSDS and Wexner questionnaires resulted significantly improved after surgery, without statistical differences between the studied surgical procedures.Conclusion: Laparoscopic continuous locked 0 absorbable suture for LVR mesh fixation guaranteed a faster and effective alternative to multiple interrupted sutures. The significant OT reduction linked to this technique should be considered even more helpful when performing a highly complex surgery such as LVR.Clinical Trial Registration: NCT05254860 (13/02/2017). [ABSTRACT FROM AUTHOR]

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.

Background: As laparoscopic repair of groin hernia is gaining popularity; most surgeons argue over which mesh fixation techniques are the best. Objective: The present study was conducted to compare the outcomes of mesh fixation using fibrin glue versus tackers in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia, with the ultimate goal of bettering the health and happiness of inguinal hernia patients. Subjects and Methods: This study included a total of 24 inguinal hernia patients chosen for laparoscopic transabdominal preperitoneal repair with mesh fixation by fibrin glue versus tackers, attending at General Surgery Department, Zagazig University Hospitals. Patients were randomly divided into 2 equally groups: Group (A) A fibrin glue was used to fix the mesh and Group (B) Using tackers, to fixed the mesh. Results: There was a statistically significant difference between the groups investigated in terms of operative time, with the fibrin glue group taking significantly longer than the tackers group. Within-day pain and length of hospital stay did not differ significantly between the groups. While return to daily activity was faster in fibrin glue groups. The cost of all cases of fibrin glue group was lower than that of tackers group. Conclusion: It could be concluded that mesh fixation by fibrin glue is better than tacker as mesh fixation with glue causes less post-operative pain and less analgesia is needed as well as low financial cost. [ABSTRACT FROM AUTHOR]

Purpose: This study reports economic evaluation of mesh fixation in open and laparoscopic hernia repair from a prospective real-world cohort study, using cost-effectiveness analysis (CEA) and cost-utility analysis (CUA).Methods: A prospective real-world cohort study was conducted in two university-based hospitals in Thailand from November 2018 to 2019. Patient data on hernia features, operative approaches, clinical outcomes, associated cost data, and quality of life were collected. Models were used to determine each group's treatment effect, potential outcome means, and average treatment effects. An incremental cost-effectiveness ratio was used to evaluate the incremental risk of hernia recurrences.Results: The 261 patients in this study were divided into six groups: laparoscopic with tack (LT, n = 47), glue (LG, n = 26), and self-gripping mesh (LSG, n = 30), and open with suture (OS, n = 117), glue (OG, n = 18), and self-gripping mesh (OSG, n = 23). Hernia recurrence was most common in LSG. The mean utility score was highest in OG and OSG (both 0.99). Treatment costs were generally higher for laparoscopic than open procedures. The cost-effectiveness plane for utility and hernia recurrence identified LSG as least cost effective. Cost-effectiveness acceptability curves identified OG as having the highest probability of being cost effective at willingness to pay levels between $0 and $3,300, followed by OSG.Conclusion: Given the similarity of hernia recurrence among all major procedures, the cost of surgery may impact the decision. According to our findings, open hernia repair with adhesive or self-gripping mesh appears most cost-effective. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the efficacy of our mesh fixation technique in robot-assisted transabdominal preperitoneal inguinal hernia repair (R-TAPP). The primary outcome was the recurrence rate. Secondary outcomes were postoperative pain, chronic pain, and return to normal activities. Methods: Between January 2018 and December 2019, we performed 208 consecutive R-TAPP in 161 patients and the mesh was fixed by three intracorporeal stiches using a Polyglactin 910 (Vicryl®) 3–0 suture. Patients were followed up at 10 and 30 days after surgery with a clinical evaluation for detection of early complications, postoperative pain, need for analgesics, return to normal activities, and satisfaction rate. Patients were further followed up at study conclusion in February 2021 for recurrence and chronic pain detection. Results: Painkillers were stopped by 57% of the patients after the first postoperative day and by 96% after 1 week. Chronic pain (> 3 months after surgery) was observed in three patients (1.8%) and only one of them was treated with percutaneous ilioinguinal-iliohypogastric nerve infiltration. After a mean follow-up of 24.0 ± 6.7 months, only 1 recurrence (0.48%) was clinically detected and confirmed by a CT-scan. Conclusions: The 3-point mesh fixation technique is feasible during robot-assisted TAPP repair for inguinal hernia and seems to be a viable alternative to other fixation methods. Further long-term controlled investigations are needed to understand if this technique is effective in influencing recurrence and chronic pain rates. [ABSTRACT FROM AUTHOR]

Purpose: Self-fixed mesh is an alternative to suture mesh fixation in inguinal hernia repair. The aim of this study was to evaluate postoperative pain after open inguinal hernia surgery using self-fixed meshes. Methods: A randomized clinical trial comparing self-adhesive mesh (Adhesix™) and self-gripping mesh (Progrip™) was conducted from November 2018 through March 2021. Patients included were male, 18–85 years old, and suitable for day case surgery. The primary endpoint was the number of patients needing follow-up visits due to postoperative pain during the first 3 postoperative months. Secondary endpoints included the intensity of pain, the time of return to work and normal daily activities, quality of life measures and postoperative complications. Results: 270 patients were enrolled, 132 received Adhesix™ mesh (A group) and 138 Progrip™ mesh (P group), 231 (85.6%) completed 1- or 3-month follow-up. The number of patients needing follow-up for postoperative pain was significantly higher in the P group (19 vs. 4, p = 0.001). The P group had higher numeric rating scale of pain while coughing (P 0.50 vs. A 0.20, p = 0.024) and during exercise (P 1.02 vs. A 0.60, p = 0.057) at 3 months postoperatively. The time of return to normal activity was 16.6 days in the A group and 22.9 days in the P group, (p = 0.004). The postoperative day being fit for work was sooner for the A group (14.3 days vs 17.8 days, p = 0.009). Conclusion: This study demonstrated an advantage of self-adhesive mesh over self-gripping mesh with respect to acute postoperative pain and thus faster recovery after surgery. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repair is the most frequently performed operation in general surgery. The Lichtenstein repair involves the implantation of a mesh prosthesis ventral to the transversalis fascia. Postoperative pain and disability are frequent after the introduction of tension-free surgical repair with the use of prosthetic mesh, patient's comfort was reported to be substantially improved over that obtained by the traditional, tension-producing techniques. The use of cyanoacrylate (CA) as a way of securing the mesh could lead to better results and avoid tension on the pubis, muscles, or nerves. Method: Prospective observational study for 6 months at General Surgery Department at Zagazig University Hospitals.24 patients were divided into two groups: group A undergoes hernioplasty using glue for mesh fixation and group B using sutures fixation. Patients were followed for 6 months for post-operative pain, recurrent, and complication. Results: In our analysis mean age of the glue group was 50±7 years while in the sutures group was 49.3±6.7 years. mean operation time in the glue group was 41.2±5.1 min while in the sutures group was 47.6±4.9 min with statistically significantly higher mean operation time in the sutures group. In long-term follow-up showed no significant difference between both groups. Conclusion: According to the results obtained in our study, it seems that the Histoacryl glue can be a good alternative for the fixation of mesh in Lichtenstein inguinal hernia repair, mimicking the tissue incorporation and mechanical behavior of sutures with a shorter operating time. It is accompanied by a reduction in chronic inguinal pain. [ABSTRACT FROM AUTHOR]

Background There are different options for mesh fixation and peritoneal flap (PF) closure in the laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair. There is no best operative technique with wide variations in these options. In our study, we aimed to compare the outcomes of totally sutured technique (for mesh fixation and PF closure) and the tacks technique in TAPP laparoscopic inguinal hernia repair regarding operative time, cost benefits, and postoperative complications. Patients and methods This is a prospective randomized controlled study performed at Ain Shams University Hospitals between February 2019 and February 2022. It included 80 patients diagnosed as having an inguinal hernia and underwent laparoscopic TAPP repair. The patients were divided equally into two groups according to the method of mesh fixation and PF closure: group A: totally tacks and group B: totally sutured. Results We had a highly significant difference between both groups regarding operative time (87.5 min in group A vs. 117 min in group B). We had a nonsignificant difference between both groups regarding operative complications. Both groups did not show a significant difference in the hospital stay (25.6 h in group A vs. 23.6 h in group B). There was a nonsignificant difference between both groups in inguinoscrotal edema/hematoma, surgical-site infection, and recurrence. There was a nonsignificant difference between both groups in early postoperative pain, while the late pain was significantly less in the suture group. Regarding the cost analysis, group B was cost-effective compared with group A. Conclusion Although the totally sutured technique (for mesh fixation and PF closure in laparoscopic TAPP inguinal hernia repair) was a significantly longer in operative time, it provided a significant improvement in late postoperative pain with a significantly lower cost than the tack technique with no significant difference in recurrence at short-term follow-up. [ABSTRACT FROM AUTHOR]

Background: In general surgery, the most common technique is inguinal hernia repair. A mesh prosthesis is implanted ventral to the transversalis fascia in the Lichtenstein repair. After the introduction of tension-free surgical repair with the use of prosthetic mesh, patients' comfort was reported to be significantly improved over that acquired by traditional, tension-producing procedures. The use of cyanoacrylate (CA) to secure the mesh may result in better results and reduce tension on the pubis, muscles, and nerves. Objectives: Our study aimed to clarify the efficacy and complications of cyanoacrylate glue and nonabsorbable sutures for mesh fixation in Lichtenstein hernia repair techniques. Matrials and Method: Prospective observational study for 6 months at General Surgery Department, Zagazig University Hospitals. 24 patients were divided into two groups. Group A undergoes hernioplasty using glue for mesh fixation and group B using sutures fixation. Patients were followed for 6 months for post-operative pain, recurrence, and complication. Results: In our analysis the mean age of glue group was 50 ± 7 years, while in the sutures group it was 49.3 ± 6.7 years. Mean operation time in the glue group was 41.2 ± 5.1 min, while in the sutures group it was 47.6 ± 4.9 min with statistically significantly higher mean operation time in the sutures group. There was no substantial difference between the two groups after a considerable period of follow-up. Conclusion: Histoacryl glue appears to be a promising alternative for mesh attachment in Lichtenstein inguinal hernia repair. According to our data, it showed replication of tissue integration and mechanical behavior of sutures while requiring less time to do. It's also associated with a decrease in persistent inguinal pain. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: A hernia is an abnormal protrusion of the viscus through the normal or abnormal opening of its containing cavity. Lichtenstein tension-free mesh repair is a commonly performed surgery for hernia. Various studies have revealed atraumatic fixation of the mesh produces less pain without compromising the outcomes., Methods: This is a prospective analytical study conducted in a tertiary hospital over a year. Eighty patients with primary inguinal hernia undergoing open mesh repair were enrolled and divided into two groups with 40 patients in each group. Mesh fixation was done with N-butyl 2 cyano-acrylate glue in one group, while polypropylene 2-0 suture in the other group. Postoperative pain, the number of dosages of analgesia required, the incidence of hematoma/seroma formation, surgical site infection, and length of hospital stay were compared between the two groups. Data were analyzed using SPSS 25., Results: Visual analog scores were significantly reduced in the glue group at 12 h and 24 h ( P <0.05) with a reduction of the mean number of analgesic doses from 6.42±0.984 in the suture group to 5.95±0.597 in the glue group ( P <0.05). The operating time was significantly reduced from 70.03±4.376 minutes in the suture group to 58.43±4.540 min in the glue group ( P <0.05), while there was no significant difference in the length of hospital stay. Five percent of cases in the suture group developed seroma while no SSI was reported in this study., Conclusions: This study demonstrates mesh fixation with cyanoacrylate glue in open hernioplasty for primary groin hernias is associated with reduced immediate postoperative pain, dose of analgesia required, and operating time in comparison to fixation with suture., Competing Interests: The authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

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. 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. 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. The developed polyurethane-based adhesives are a promising alternative with sufficient adhesive strength and superior short-term biocompatibility to cyanoacrylate. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair is among the most frequent elective or emergency operations performed in general surgical practice. Lichtenstein hernia repair is considered the gold standard for managing such cases. Postoperative complications especially post-surgical chronic groin pain stands still as a very disabling complication. In this study, we investigated the chronic postoperative pain on 2 different types of meshes. Materials and Methods: This is a retrospective study evaluating the results of open herniorrhaphy with self gripping mesh or regular prolene mesh. Patients included the study that was male and aged 18-65 years, which presented with unilateral inguinal hernia and were favorable with Lichtenstein tension-free herniorrhaphy using mesh. Results: The median duration of the operation was 44.6 m ± 6.1 on Group-1 and the median duration of the operation was 24.6 m ± 5.4 on Group-2, as significantly shorter than Group-1 (p< 0.001). The median hospital stay of the patients was 1 day and no statistically significant difference has detected between groups. At follow-up on the third month, the rate of the patients with complaints of mild chronic groin pain in Group-1 was % 11.1 vs none in Group- 2(p<0.05). No recurrence has been detected in both groups after 8.4 months of follow-up. Conclusions: Our experience of lightwight self-gripping mesh demonstrates that the material is both safe and effective in matters of postoperative complications and recurrence and is very promising in prohibiting chronic groin pain. [ABSTRACT FROM AUTHOR]

Background: To clarify the optimum mesh-tack ratio MTR (mesh area in cm2 divided by the number of fixation tacks) in laparoscopic ventral and incisional hernia repair, we compared IPOM Plus procedures with more intensive mesh fixation to those with standard mesh fixation. Methods: In a retrospective cohort study, 84 patients (mean hernia width 6.6 ± 4.4 cm) intraoperatively received an intensive mesh fixation I-IPOM Plus with MTR ≤ 4:1 (e.g. ,150 cm2 mesh fixed by 50 tacks) and 74 patients (mean hernia width 6.7 ± 3.4 cm) received a standard mesh fixation S-IPOM Plus with MTR > 4:1 (e.g., 150 cm2 mesh fixed by 30 tacks) at a community hospital between 2014 and 2017. Outcomes in recurrence rates, immediate and chronic postoperative pain, as well as long-term functionality of the abdominal wall were then evaluated. Results: After a mean follow-up time of 34 months, a 2.3% recurrence rate in I-IPOM Plus patients and a 13.5% recurrence rate in S-IPOM Plus patients were recorded (p = 0.018). The recurrence was associated with large hernia > 10 cm (OR 3.7, 95% CI 1.3–5.4) and MTR > 5 (OR 2.4, 95% CI 1.1–3.8) in the multivariate analysis. There was a positive correlation between immediate postoperative pain intensity measured on day 7 and number of fixation tacks placed (I-IPOM Plus: mean 4.5 ± 2.5 VAS versus S-IPOM Plus: mean 2.7 ± 2.0 VAS, p = 0.001). However, there were no outcome differences in terms of length of immediate postoperative pain experience, sick leave duration, chronic pain rate and long-term abdominal wall functionality between these two groups. Conclusion: For ventral and incisional hernia patients with multiple recurrence risk factors, a mesh-tack ratio MTR ≤ 4:1 should be applied in laparoscopic IPOM Plus procedures. [ABSTRACT FROM AUTHOR]

Surgeons have long grappled with categorizing complex hernias, leading to varied interpretations and fluctuating incidence rates. Complex Abdominal Wall Reconstruction (CAWR) addresses repairs for large hernias, with defined factors including size, previous repairs, mesh placement, infections, and comorbidities. This review explores pivotal surgical techniques for complex hernia repair, starting with Preoperative Progressive Pneumoperitoneum (PPP) and progressing to innovative methods like Botulinum Toxin Type A. Mesh fixation, both open and laparoscopic, plays a crucial role, with synthetic and biological mesh options discussed. Hybrid techniques and the "sandwich" approach are proposed for intricate cases. Each technique presents advantages and limitations, emphasizing the ongoing quest for optimal outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Meza-Hernandez et al.)

INTRODUCTION: Since the introduction of the laparoscopic technique for tension-free inguinal hernia repair, various mesh fixation techniques have been adopted. The need for mesh fixation during the surgery is still under debate. We conducted our study to compare the outcomes of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair with (MF) and without (NMF) mesh fixation. PATIENTS AND METHODS: One hundred and fifty-seven patients underwent laparoscopic inguinal hernia repair without mesh fixation during 2010–2014. Of these, 113 (71.9%) agreed to participate in our trial, underwent physical examination, and filled out a questionnaire regarding their satisfaction with the surgery outcome. The data collected from medical records and results of the examination and the questionnaire were processed statistically and compared to the results of a previous study, which included patients who underwent TEP with mesh fixation. RESULTS: Mean follow-up was about 3 years in both groups. Duration of procedure and length of hospital stay were shorter in the NMF group. Patients without mesh fixation had less pain and earlier return to work and physical activity. There was no significant difference in recurrence rate between NMF and MF groups (5.6% and 4.6%, respectively). The majority of recurrences in the MF group were among patients in whom a nonsplit mesh was used. Surgery satisfaction, however, was significantly higher in the MF group. CONCLUSION: TEP without mesh fixation results in better surgical and postoperative outcome comparing with mesh fixation. Overall hernia recurrence rate was similar in patients with and without mesh fixation. Regular follow-up of at least 18 months is recommended to define true recurrence rate.

BACKGROUND: The lumbar area is limited by the bone structures (superiorly by the 12th rib and inferiorly by the iliac crest); furthermore, several important nerves, including the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal and iliohypogastric nerves, are all exposed in this area after retroperitoneal dissection during lumbar hernia repair, which render the risk and challenge for lumbar hernia repair and mesh fixation. In addition, the superior and inferior lumbar hernias, although had the same name of lumbar hernia, are quite different according to the anatomical location, and there is no standard and preferred method for lumbar hernia repair. In the present study, we present our techniques of total extraperitoneal (TEP) superior and inferior lumbar hernia repair. METHODS: The TEP approaches were performed in the superior and inferior lumbar hernias. Due to the different anatomic locations of the superior and inferior lumbar hernias, the trocar sites were also different. In the present procedure, with the use of self-gripping mesh, the traumatic fixation was avoided. RESULTS: After TEP lumbar hernia repair, both patients had minimal postoperative pain and were discharged 1 day and 3 days after operation without complications, respectively. CONCLUSION: Different pathways and trocar arrangement are necessary according to the different locations of superior and inferior lumbar hernias. The use of self-gripping mesh in the retroperitoneal space avoids the traumatic fixation, and TEP could be a promising technique for primary lumbar hernia repair.

Background: Mesh fixation during laparoscopic totally extra peritoneal repair is thought to be necessary to prevent recurrence of infections and post-operative complications. However, mesh fixation might increase the postoperative complications and chronic pain. This study was to describe the experience of a single surgeon at R.G. Kar Medical College and Hospital performing this operation. This study evaluates the outcomes of laparoscopic hernioplasty performed with and without mesh fixation at our institution. Aims and Objective: To compare advantage of non-fixation versus fixation of mesh in laparoscopic Totally Extra peritoneal (TEP) repair of inguinal hernias. This study was conducted for analysis of outcome with respect to pain, operative time, intra and postoperative complication, days of hospital stay, recurrence regarding the procedure between fixation and non-fixation of mesh in totally extra peritoneal repair of inguinal hernia. Materials and Methods: The study was conducted in the Department of Surgery, R.G.Kar Medical College and Hospital from January 2011 to April 2012. All patients admitted in General surgical unit presenting with uncomplicated unilateral inguinal hernias were included. A total of 60 patients were included in the study, of which 30 patients underwent TEP repair without fixation of mesh and for remaining 30 patients the mesh was fixed using metallic tacks. Results: Difference in average pain score at 24 hrs, 72 hrs, 1 month and 6 months was significant statistically (p =0.003, p = 0.003, p< 0.001 and p=0.001 respectively) when compared in both groups. There was no recurrence in the study period in either of the groups. The duration of operative time and days of hospital stay was higher in fixation group and was statistically significant. Conclusion: Mesh fixation appears to be disadvantageous in TEP repair of inguinal hernias compared to non- fixation of mesh as it is associated with higher operative time, higher postoperative complication and an increased likelihood of developing chronic groin pain. The omission of mesh fixation did not increase the risk of early hernia recurrence.

Background: In open anterior inguinal mesh hernioplasty, the commonly used method for mesh fixation is by polypropylene sutures which involves extensive mesh fixation and placement of sutures into periosteum of pubic symphysis, thereby increasing the operative time with attendant risk of infection of the prosthetic material. An alternative to sutures is the use of staples which are easy to use and quick to apply. We explored the use of staples in securing the mesh in inguinal hernioplasty. Methodology: A prospective comparative study of 400 patients who underwent inguinal mesh hernioplasty with 200 patients selected randomly each in polypropylene suture (PPSG) and staple group (SG) was performed. Postoperatively patients were made ambulatory on the same day of surgery and discharged from hospital on 1st or 2nd day in both the groups. Follow-up was carried out in 1 week, 2 months, 6 months, 1 year, 2 years, and 3 years and the patients were assessed for wound infection, hematomas, local pain, return to work, recurrence if any, and other miscellaneous complications if any. Results: The mean age of patients in our study in polypropylene suture group and staple group was 46.75 years and 46 years, respectively. 80% (160 patients) in polypropylene suture group and 75% (150 patients) in stapler group had indirect hernia. The mean operative time in PPSG and SG group was 59.25 minutes and 45 minutes, respectively (p value0.05). Overall the complication rate was the same in the two groups with no statistically significant differences observed (P value >0.05). There was 0% recurrence rate in 6 months and 1 year of follow-up in both groups. However, in 3-year follow-up 20 patients (10%) in PPSG and 2 patients (1%) in SG had recurrence (P value=0.0001). Conclusion: The technique of mesh fixation with skin staples is as effective as conventional fixation with polypropylene sutures, with an important added advantage of a significant reduction in the operative time and an early return to work. At the same time this technique does not have any additional complications compared to traditional Lichtenstein method. Good tissue penetrance and effective mesh anchorage are achieved when staples are utilized to secure the mesh. [Arch Clin Exp Surg 2018; 7(1.000): 7-12]