Mesh Fixation versus Non Fixation in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair

Abstract

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. In the laparoscopic procedure, tension-free repair is achieved by placement of a prosthetic mesh to cover the entire groin area, including the sites of direct, indirect, and femoral hernia. The laparoscopic approach is based on the principle of tension-free repair, which has been well established by open operation by Fitzgibbons et al. Developments in laparoscopic techniques to repair inguinal hernias using polypropylene flat mesh have led to valuable options for the management of inguinal hernias. Several studies have shown that laparoscopic repair offers the advantage of minimally invasive surgery to the patient. The mesh can be placed without fixation or can be fixed into place with tuckers. These metal tuckers increase the cost and there is an increased incidence of chronic groin pain. Although recurrence rates remain the most important outcome parameter, recently, discussions on inguinal hernia repair focus more on chronic pain, rather than the rate of recurrence. The number of studies