M S Abdelhamid, MD1, Ahmed M Sadat, MD1, Tamer M Nabil, MD1, Mohamed S Abdelbasset, MD1, Amr M Ali, MD1, Hesham A Nafady, md1, Mmesoha H Abdelmola, MD1, Ahmed Z Gharib, MD2, Adel M Abdulla, md2, Assad F Salama, MD3. 1Bani swif university -faculty of medicine, 26 th October university, 3Theodor Bilharz
Purpose :To find out which is more satisfactory to the patients external fixation or internal fixation
Background: Tapp with external fixation is a new technique in which there is a marked reduction in the cost without affecting the outcome.
Methods: In 80 patients the mesh were fixed from the interior using staples while in the other 80 patients it is fixed to the exterior using prolene threads ( Abdelhamid Technique) .
Patients :A prospective study for laparoscopic TAPP inguinal hernia repair on 160 patients between September 2008 until May 2013 and we follow the patients till May 2014. In 80 we fixed the mesh to the exterior and in another 80 from the interior. There were 90 patients with direct inguinal hernia 45 done through external fixation( gp1) another 45 through internal fixation of the mesh(gp2), 70 patients with indirect inguinal hernia 35 external fixation(gp3) 35 internal fixation (gp4).We follow the patients for recurrence, impulse on cough, inguinal pain and sense of discomfort.
Results: The operative time ranged from 35 – 70minutes for external fixation,30 -60 minutes for internal fixation .
During this period we did not encounter any recurrence, but in group 1 there is one patient complained of impulse on cough and in group 2 there were three had the same complain.
Regarding pain non of the external fixation patients complained of groin pain while in group 2 there were two and in group 4 there were two patients complained of groin pain .
Conclusion: In addition to much reduction in the cost,external fixation is associated with no groin pain compared to internal fixation and much less incidence of impulse of cough making this technique more acceptable to the patients
Key words: Laparoscopic transabdominal preperitoneal inguinal hernia repair – mesh fixation – cost -stapling.