Mesh fixation techniques in laparoscopic hernia repair: A current evidence-based review

This evidence-based review analyzes mesh fixation techniques in laparoscopic inguinal hernia repair, highlighting a significant shift from traditional penetrating methods, like tacks and sutures, to atraumatic alternatives such as tissue adhesives and non-fixation approaches. The primary driver for this change is the goal of minimizing chronic postoperative pain, a significant complication associated with traumatic fixation, while maintaining low hernia recurrence rates. For small to medium-sized hernias (<3-4 cm), numerous studies show that non-fixation, particularly in Totally Extraperitoneal (TEP) repair, and the use of adhesives do not increase recurrence but significantly reduce chronic pain, operative time, and costs. However, for large medial hernias, fixation is still recommended to prevent mesh migration and recurrence, with tissue adhesives presenting a safer alternative to tacks. The review concludes that the ideal fixation strategy is a "tailor-made" decision, balancing hernia characteristics, surgical technique, and patient factors to optimize outcomes, with emerging technologies like robotics and next-generation meshes promising even less painful solutions in the future.