Ragui W Sadek, MD, FACS, Andrew M Wassef, BS. Rutgers Robert Wood Johnson Medical School
Inguinal hernias account for 75% of abdominal wall hernias with a greater prevalence in male patients. Being one of the most common procedures among general surgeons, laparoscopic repair of inguinal hernia spurs quite the debate with respect to the topic of fixation. Secure fixation of mesh during laparoscopic total extraperitoneal inguinal hernia repair (TEP) is thought to be a necessity to severely reduce the rate of recurrence. Yet, multiple tacking’s may lead to increased pain, prolonged discomfort postoperatively, and lengthened hospital stays. The following study questioned whether fixating mesh during TEP inguinal hernia repair with one tack on the public tubercle is sufficient for reducing the rate of recurrence, while decreasing complications postoperatively in comparison to patients who have received 2,3,4+ tacking’s.
A randomized prospective single-blinded study was carried out in 110 patients who underwent laparoscopic TEP inguinal hernia repair with 1 tack (Group A=30), with 2 tacks (Group B=30), with 3 tacks (Group C=30) with 4+ tacking’s (Group D=20) fixation of the mesh.
Patients in Group A, B, C, D showed no notable difference in the rate of inguinal hernia recurrence with respect to each other (P=0.001). Patients in Group A, B, C, D showed no notable difference in the length of hospital stay (avg= 9.6hrs). Patients in Group C (p=0.86) and Group D (p=0.12) used more postoperative narcotic analgesia in the PACU when compared to Group A, (p=0.01) and Group B (p=0.04). Patients reported greater pain in Group D (p=0.1) than Group C (p=0.07). Group A (p=0.02) and Group B (p=0.03) showed no significance for pain post operatively. The average follow-up time was 3-24 months, median=15).
Reduction of tacking during laparoscopic TEP inguinal hernia repair significantly minimizes the use of postoperative narcotic analgesia, and leads to a significant reduction in postoperative pain, yet does not have any effect on the length of hospital stay. Reduction of tacking to one tack on the pubic tubercle does not lead to an increased rate of recurrence.