Early Outcomes of Self-Adhering vs. Conventional Polyester Mesh in Laparoscopic Inguinal Hernia Repair

Shani Belgrave, MD, Andrew S Wright, MD, Zoe E Parr, MD, Hinojosa Marcelo, MD, Giana Davidson, MD. University of Washington

The need for mesh fixation during laparoscopic inguinal hernia repair is controversial. Many surgeons use fixation devices to prevent mesh migration and hernia recurrence despite evidence suggesting that mesh fixation is unnecessary and post-operative pain may be related to the use of tacks. Recently we adopted a self-adhering mesh designed for laparoscopic placement without tack fixation (Laparoscopic Progrip, Medtronic). There have been no known early clinical outcome comparisons between conventional mesh and self-adhering mesh for laparoscopic hernia repair.

Methods: All laparoscopic inguinal hernias performed at a single academic institution by 4 experienced laparoscopic hernia surgeons between 1/1/14 and 9/8/15 were retrospectively analyzed through chart review. Self-adhering mesh was introduced in 8/14 with implementation over the following months. Costs of mesh and tackers were obtained from hospital materials management. Data was analyzed using SPSS.

Results: There were 45 inguinal hernia repairs performed using flat sheet self-adhering mesh, and 46 using conventional polyester mesh in a pre-shaped configuration (anatomic Parietex, Medtronic). Median time from surgery to date of review was 449 days for conventional, compared to 206 for self-adhering. Demographics were similar (age, sex, BMI, type of hernia) between groups (ns). Tacks were used in 3/45 self-adhering (6.7%) and 38/46 conventional (82.6%). In the self-adhering group there were 19 bilateral hernias and 12 recurrent hernias repaired, compared to 14 and 6 in the conventional group, respectively (ns). 2 repairs in each group were performed as TAPP, with the remainder being TEP. Operative time was median 95±34min for self-adhering and 94±37min for conventional (ns).  In the self-adhering group there were 3 spermatic cord hematomas, 4 seromas, 2 episodes of urinary retention, 1 scrotal swelling, and 2 patients with pain lasting > 1 month. In the conventional group there were 2 hematomas, 1 scrotal swelling, and 1 urinary retention. 5 patients had pain lasting >1month, with 1 requiring reoperation for a retained cord lipoma. There was 1 early recurrence in a large pantaloon hernia repaired with conventional mesh and no tacking. Unit costs were $419/tacker, $314/self-adhering mesh and $128/conventional mesh.  Given an overall bilateral hernia rate of 36% and consistent tacker use, switching to self-adhering mesh is estimated to save $3,552/year.

Conclusions: Self-adhering mesh is cost-effective when eliminating the use of tacking devices. Operative times and early outcomes are similar to conventional mesh. Long-term follow-up is needed to analyze recurrence, clinical outcomes, and rates of chronic pain.

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