Andrew Bates, MD, Mark Reiner, MD, Andrew Wu, MD, Brian P Jacob, MD. Mount Sinai Medical Center, NYC.
Background: The use of self-gripping mesh during laparoscopic TEP inguinal hernia repairs may eliminate the need for any additional fixation without added concern for mesh migration. Long term outcomes are not yet prospectively studied in a controlled fashion.
Methods: Under IRB approval, from July 2011 – Sept 2012, 102 hernias were repaired laparoscopically with self-gripping mesh without additional fixation. Patients were followed for at least one year. Demographics and intraoperative data (defect location, size, mesh deployment time) are recorded. Carolinas Comfort Scale ™ (CCS), a validated 0-5 pain/quality of life (QoL) score where a mean score of >1.0 means symptomatic pain, is employed in the recovery room (RR), at 2 wks, and at 1 year. Morbidities, narcotic usage, days to full activity and return to work, and CCS scores are reported.
Results: 64 patients with 102 hernias completed a mean 15.1 months follow up. 20 hernias were direct defects (average size 2.8cm). Mesh deployment time was 198 seconds. RR pain was 1.1 / 5. Total average oxycodone/acetaminophen (5mg/325mg) usage = 5.4 tablets, days to full activity was 1.7, and return to work was 4.5 days. 12 small asymptomatic seromas were palpated without any recurrences or groin numbness. All seromas resolved by the 6 month visit. Transient testis discomfort was reported in 8 patients. Urinary retention was 3%. Mean CCS™ scores for groin pain laying, bending, sitting, walking, and step-climbing were 0.2, 0.6, 0.3, 0.5, and 0.07 respectively. At the first postop visit, 6% had symptomatic pain (CCS >1). At 15.1 months, no patients had symptomatic pain (CCS scores = 0.05, range 0 – 0.8). There are no recurrences.
Conclusions: Self-gripping mesh can be safely used during laparoscopic TEP inguinal hernia repairs. Recovery was rapid. In this cohort, there were no reports of chronic pain or recurrences.
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