Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair Using 3-dimensional Mesh Without Mesh Fixation

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Background:Approximately one fifth of patients suffer from inguinal pain after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. There is existing literature suggesting that the staples used to fix the mesh can cause postoperative inguinal pain. In this study, we describe our experience with laparoscopic TEP inguinal hernia surgery using 3-dimensional mesh without mesh fixation, in our institution.Materials and Methods:A total of 300 patients who had undergone laparoscopic TEP inguinal hernia repair with 3-dimensional mesh in VKV American Hospital, Istanbul from November 2006 to November 2015 were studied retrospectively. Using the hospital’s electronic archive, we studied patients’ selected parameters, which are demographic features (age, sex), body mass index, hernia locations and types, duration of operations, preoperative and postoperative complications, duration of hospital stays, cost of surgery, need for analgesics, time elapsed until returning to daily activities and work.Results:A total of 300 patients underwent laparoscopic TEP hernia repair of 437 inguinal hernias from November 2006 to November 2015. Of the 185 patients, 140 were symptomatic. Mean duration of follow-up was 48 months (range, 6 to 104 mo). The mean duration of surgery was 55 minutes for bilateral hernia repair, and 38 minutes for unilateral hernia repair. The mean duration of hospital stay was 0.9 day. There was no conversion to open surgery. In none of the cases the mesh was fixated with either staples or fibrin glue. Six patients (2%) developed seroma that were treated conservatively. One patient had inguinal hernia recurrence. One patient had preperitoneal hematoma. One patient operated due to indirect right-sided hernia developed right-sided hydrocele. One patient had wound dehiscence at the umbilical port entry site. Chronic pain developed postoperatively in 1 patient. Ileus developed in 1 patient.Conclusions:Laparoscopic TEP inguinal repair with 3-dimensional mesh without mesh fixation can be performed as safe as repair with tack fixation.

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