Mesh Fixation in Inguinal Hernia Repair: Are We Close to a Definitive Solution?

Abstract Introduction Inguinal hernia repair is the most performed surgical procedure and one of the most serious post-operative complications is still chronic pain, literature describes rates of chronic pain of 5–10%. Laparoscopic repairs can prevent post-operative pain due to a minimally invasive approach reducing the manipulation of the layers covering nerves and vessels in the inguinal area. The use of staples to fix the mesh could cause post-operative pain, for this reason in the last decade several studies comparing glue fixation to staples have been performed, showing better results for chronic pain and no differences in recurrence rate. In these last years a step forward has been done, the comparison between glue fixation versus no fixation at all, granted by the tridimensional shape of some meshes in order to reduce the operating costs. These studies showed no difference between glue fixation and no fixation in the recurrence rate. Materials and Methods From 15th of January 2023 till now we performed 100 laparoscopic inguinal hernia repairs, 55 for bilateral inguinal hernia and 45 for monolateral hernia, median age was 58 yrs old. 36 of them were treated with TEP technique (9 with non-absorbable tacks and 27 without fixation), 64 with TAPP technique (2 with non-absorbable tacks and 62 without fixation). The median operating time was 50 minutes, in the TAPP group 18 direct hernias were detected and the difect was closed with an absorbable running suture, in the TEP group 7 direct hernias were detected and no suture of the defect was performed. Intraoperative complications were: in the TAPP group 1 bladder lesion treated with direct suture, in the TEP group 1 mild bleeding. Post-operative complications were: 1 rectus hematoma treated laparoscopically and 29 cases of seroma (13 bilateral, 16 monolateral). Results After 6 months of follow up no recurrence was detected, 1 case of moderate post-operative pain (nociceptive pain: painscore 9) was treated with anti-inflammatory medicines. Discussion Laparoscopic repairs of inguinal hernia nowadays should provide an easy recovery to the normal quality of life with reduction of social costs. Our results show that no mesh fixation could be performed safely with good results concerning the percentage of recurrences.