Is mesh fixation in TAPP and TEP still necessary?

Abstract

One of the most serious complications after inguinal hernia repair is still the occurrence of chronic pain. The literature describes rates of severe chronic pain of 3%-6%. Laparo-endoscopic inguinal hernia repair is favored to prevent postoperative pain through a minimally invasive approach and sparing of the layers of tissue covering nerves and vessels in terms of reduced risk of damage to these structures. However, the method of fixation of the mesh is still controversial discussed. The use of these penetrating devices such as staples and staplers has been shown to often be complicated by injury to nerves and vessels and occurrence of postoperative pain. The shift to completely atraumatic fixation using adhesives (fibrin glue, cyanoacrylate) began in the early part of this century. Several studies confirmed less postoperative pain after mesh fixation by glue compared to stapler or tacker. Historically, the TEP technique has always been performed without any fixation. Several studies comparing fixation versus non-fixation have been performed in TEP repair and found results with no increase in recurrence rate. Notwithstanding that very few studies comparing fixation versus no fixation with exclusion of large medial inguinal hernias have been published on this topic in TAPP repair, identical results to those with TEP repair were obtained. On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair except for large medial and combined inguinal hernias. If mesh fixation is required, atraumatic techniques should be used.

Keywords

Laparo-endoscopic inguinal hernia repair / TAPP / TEP / mesh fixation / non-fixation / atraumatic fixation / glue fixation

References

[1] Arregui ME,Davis CJ,Nagan RF.Laparoscopic inguinal herniorrhaphy. Techniques and Controversies.Surg Clin North Am1993;73:513-27

[2] Ferzli G,Huie F,Usal H.Endoscopic extraperitoneal herniorrhaphy. A 5-year experience.Surg Endosc1998;12:1311-3

[3] Bittner R,Kraft K,Schwarz J.Die laparoskopische Hernioplastik (TAPP)-Komplikationen und Rezidive bei 900 Operationen [Laparoscopic hernioplasty (TAPP)-complications and recurrences in 900 operations].Zentralbl Chir1996;121:313-9

[4] Bullen NL,Antoniou SA,Fortelny RH.Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis.Hernia2019;23:461-72

[5] Reinpold W,Schroeder M,Rohr M.Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia.Hernia2015;19:539-48

[6] guidelines for groin hernia management.Hernia2018;22:1-165 PMCID:PMC5809582

[7] Prakash PS,Salgaonkar HP.The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias.Asian J Surg2019;42:995-1000

[8] Christoffersen MW,Helgstrand F.Recurrence rate after absorbable tack fixation of mesh in laparoscopic incisional hernia repair.Br J Surg2015;102:541-7

[9] Garg P,Varghese V.Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias.Surg Endosc2009;23:1241-5

[10] Köckerling F,Adolf D.Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures.Surg Endosc2018;32:2222-31 PMCID:PMC5897456

[11] Zhu Y,Li J.Closure of Direct Inguinal Hernia Defect in Laparoscopic Hernioplasty to Prevent Seroma Formation: A Prospective Double-blind Randomized Controlled Trial.Surg Laparosc Endosc Percutan Tech2019;29:18-21

[12] Usmani F,Malik S,Rao J.Effect of direct defect closure during laparoscopic inguinal hernia repair ("TEP/TAPP plus" technique) on post-operative outcomes.Hernia2020;24:167-71

[13] Ng AY,Ching SS,Wong ASY.Does primary closure of direct inguinal hernia defect during laparoscopic mesh repair reduce the risk of early recurrence?.Hernia2020;24:1093-8

[14] Clout E,Douglas C.Long-term follow-up of endoscopic totally extraperitoneal direct inguinal hernia repair using the Endoloop technique.Surg Endosc2019;33:2967-74

[15] Katkhouda N,Friedlander MH.Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair.Ann Surg2001;233:18-25 PMCID:PMC1421161

[16] Schwab R,Junge K.Biomechanical analyses of mesh fixation in TAPP and TEP hernia repair.Surg Endosc2008;22:731-8

[17] Brand J,Gruber K,Redl H.Transporous hernia mesh fixation with fibrin sealant in an in vitro model of spray application.J Surg Res2013;183:726-32

[18] Langrehr JM,Neuhaus P.Initial experience with the use of fibrin sealant for the fixation of the prosthetic mesh in laparoscopic transabdominal preperitoneal hernia repair.Rozhl Chir2005;84:399-402

[19] Lovisetto F,Rota E.Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study.Ann Surg2007;245:222-31 PMCID:PMC1876985

[20] Olmi S,Bertolini A,Croce E.Fibrin glue for mesh fixation in laparoscopic transabdominal preperitoneal (TAPP) hernia repair: indications, technique, and outcomes.Surg Endosc2006;20:1846-50

[21] Fortelny RH,May C.The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of a randomized controlled study.Surg Endosc2012;26:249-54

[22] Tolver MA,Juul P.Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair.Surg Endosc2013;27:2727-33

[23] Katkhouda N.A new technique for laparoscopic hernia repair using fibrin sealant.Surg Technol Int2004;12:120-6

[24] Lau H.Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial.Ann Surg2005;242:670-5 PMCID:PMC1409848

[25] Novik B,Mörk UB,Skullman S.Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period.Surg Endosc2006;20:462-7

[26] Schwab R,Kröger A.Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair.Hernia2006;10:272-7

[27] Shi Z,Zhai S,Huang D.Fibrin glue versus staple for mesh fixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia: a meta-analysis and systematic review.Surg Endosc2017;31:527-37

[28] Sajid MS,Kalra L,Baig MK.A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair.Am J Surg2013;206:103-11

[29] Kaul A,Le H.Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis.Surg Endosc2012;26:1269-78

[30] Fortelny RH,Walder N.Cyanoacrylate tissue sealant impairs tissue integration of macroporous mesh in experimental hernia repair.Surg Endosc2007;21:1781-5

[31] Pascual G,Rodriguez M.Cytotoxicity of cyanoacrylate-based tissue adhesives and short term preclinical in vivo biocompatibility in abdominal hernia repair.PLoS One2016;11:e0157920 PMCID:PMC4913938

[32] Kukleta JF,Weber M.Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate: long-term biocompatibility in over 1,300 mesh fixations.Hernia2012;16:153-62 PMCID:PMC3315639

[33] Subwongcharoen S.A randomized controlled trial of staple fixation versus N-butyl-2-cyanoacrylate fixation in laparoscopic inguinal hernia repair.J Med Assoc Thai2013;96 Suppl 3:S8-13

[34] Fortelny RH,Glaser KS.Use of fibrin sealant (Tisseel/Tissucol) in hernia repair: a systematic review.Surg Endosc2012;26:1803-12

[35] Birk D.Self-gripping Parietene and Parietex Progrip mesh laparoscopic hernia repair: have we found the ideal implant?.Surg Technol Int2012;22:93-100

[36] Li J,Cheng T.How I do it: the horizontal-bilateral unfolding method for self-gripping (Progrip™) mesh placement in laparoscopic inguinal hernia repair.Hernia2019;23:809-15

[37] Bresnahan E,Wu A,Jacob B.The use of self-gripping (Progrip™) mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair: a prospective feasibility and long-term outcomes study.Surg Endosc2015;29:2690-6

[38] Denham M,Leong M.An analysis of results in a single-blinded, prospective randomized controlled trial comparing non-fixating versus self-fixating mesh for laparoscopic inguinal hernia repair.Surg Endosc2019;33:2670-9

[39] Claus CMP,Campos ACL,Coelho JCU.Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation.JSLS2017;21:e2017 PMCID:PMC5592431

[40] Ferzli GS,Pecoraro AM Jr.Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair.J Am Coll Surg1999;188:461-5

[41] Garg P,Shereef M.Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India.Surg Endosc2011;25:3300-6

[42] Koch CA,Larson DR,Farley DR.Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh.JSLS2006;10:457-60. PMCID:PMC3015750

[43] Lau H.Selective non-stapling of mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty: a case-control study.Arch Surg2003;138:1352-5

[44] Moreno-Egea A,Morales Cuenca G.Randomized clinical trial of fixation vs nonfixation of mesh in total extraperitoneal inguinal hernioplasty.Arch Surg2004;139:1376-9

[45] Parshad R,Hazrah P.A randomized comparison of the early outcome of stapled and unstapled techniques of laparoscopic total extraperitoneal inguinal hernia repair.JSLS2005;9:403-7 PMCID:PMC3015632

[46] Taylor C,Liew V,Crampton N.Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial.Surg Endosc2008;22:757-62

[47] Tam KW,Chai CY.Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials.World J Surg2010;34:3065-74

[48] Teng YJ,Liu YL.A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair.Surg Endosc2011;25:2849-58

[49] Sajid MS,Kalra L,Sains P.A meta-analysis examining the use of tacker fixation versus no-fixation of mesh in laparoscopic inguinal hernia repair.Int J Surg2012;10:224-31

[50] Gutlic N,Nordin P,Montgomery A.Impact of Mesh Fixation on Chronic Pain in Total Extraperitoneal Inguinal Hernia Repair (TEP): A Nationwide Register-based Study.Ann Surg2016;263:1199-206

[51] Smith AI,Sedman PC.Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. A prospective randomized trial.Surg Endosc1999;13:804-6

[52] Li W,Sun Y.The effect of transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic pain and quality of life of patients: mesh fixation versus non-fixation.Surg Endosc2017;31:4238-43

[53] Roos MM,Schouten N.Higher Recurrence Rate After Endoscopic Totally Extraperitoneal (TEP) Inguinal Hernia Repair With Ultrapro Lightweight Mesh: 5-Year Results of a Randomized Controlled Trial (TULP-trial).Ann Surg2018;268:241-6

[54] Li J.Comments on "Higher Recurrence Rate After Endoscopic Totally Extraperitoneal (TEP) Inguinal Hernia Repair With Ultrapro Lightweight Mesh: 5-Year Results of a Randomized Controlled Trial (TULP-trial)".Ann Surg2019;269:e38-9

[55] Nyhus LM.Classification of groin hernia: milestones.Hernia2004;8:87-8

[56] Miserez M,Campanelli G.The European hernia society groin hernia classification: simple and easy to remember.Hernia2007;11:113-6

[57] Hollinsky C,Koch T.Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates.Surg Endosc2008;22:2679-85

[58] Currie A,Tonsi A,Taribagil S.Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis.Surg Endosc2012;26:2126-33

[59] Bakker WJ,Boschman JS.Heavyweight Mesh Is Superior to Lightweight Mesh in Laparo-Endoscopic Inguinal Hernia Repair: A Meta-analysis and Trial Sequential Analysis of Randomized Controlled Trials.Ann Surg2020;

[60] Hu D,Gao L.Lightweight Versus Heavyweight Mesh in Laparoscopic Inguinal Hernia Repair: An Updated Systematic Review and Meta-Analysis of Randomized Trials.J Laparoendosc Adv Surg Tech A2019;29:1152-62

[61] Miserez M,Aufenacker T.Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients.Hernia2014;18:151-63

[62] Mayer F,Lechner M.When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary?.Surg Endosc2016;30:4363-71 PMCID:PMC5009149