Comparison of Long-term Outcome and Quality of Life Following Laparoscopic Repair of Incisional and Ventral Hernias With Tacker Or Suture Mesh Fixation: A Prospective Randomized Controlled Study

Virinder K Bansal, MBBS MS FACS, M C Misra, MS FACS FRCS, P Singal, MBBS, K Rao, MS, S Kumar, MS, S Rajeshwari, MD, R Sagar, MD. All India Institute of Medical Sciences, New Delhi-110029, India

Background
Method of mesh fixation after laparoscopic repair of incisional and ventral hernias is still an area of debate. Patient related outcomes like chronic pain and quality of life are important determinants of the efficacy of one technique over the other. This randomized study was aimed at comparing, fixation of mesh with trans-fascial suture alone versus tacker in double crown with four corner sutures.
Materials and methods
96 patients with non-recurrent hernias with defect size ranging from 2 to 5 cm only were randomized to either Group I (tacker mesh fixation) or Group II (suture mesh fixation). Demographic profile, pre-operative and intra-operative variables, post-operative complications, hospital stay, cost and pain were compared between the two groups. Preoperative and postoperative quality of life analysis was done using SF-36v2 health survey. Patients were followed up at regular intervals and return to activity and satisfaction scores were recorded. Statistical analysis was done using SPSS 14 and p value < 0.05 was considered significant.
Results
Of 96 patients, 92 received the intended treatment. The demographic profile and pre-operative SF-36v2 scores were comparable except for gender distribution with female to male ratio significantly higher in group I. The duration, type, location, defect size and location, mesh size and type were comparable between the two groups. There were 2 conversions- one in each group. Mesh fixation time and operation time were found to be significantly higher in group II (p<0.001 for both). Early post-operative pain was found to be significantly lower in group II at 1 hour (p<0.001), 6 hours (p=0.04) and at 1 month (p=0.01). There was no significant difference in the incidence of chronic pain over a mean follow up of 22.2 months. Cost of procedure was significantly higher in group I (p<0.001). Post-operative quality of life outcomes were similar in the two groups. Patient satisfaction scores were higher in group II but this was not significant. Time to resumption of daily activities and climbing stairs was significantly shorter in group II.
Conclusion
Laparoscopic mesh repair of incisional and ventral hernias with medium sized defects using only trans-fascial sutures is better than using tacks in terms of cost-effectiveness, early post-operative pain and time to resumption of routine activities although it is associated with significantly increased operative time.