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  • Title: Total extraperitoneal laparoscopic inguinal hernia repair without mesh fixation: prospective study with 1-year follow-up results.
    Author: Messaris E, Nicastri G, Dudrick SJ.
    Journal: Arch Surg; 2010 Apr; 145(4):334-8. PubMed ID: 20404282.
    Abstract:
    OBJECTIVE: To determine the outcomes of patients undergoing total extraperitoneal inguinal hernia repair without fixation of the mesh. DESIGN: Prospective cohort. SETTING: Community teaching hospital. PATIENTS: A total of 274 consecutive patients were included in the study group. INTERVENTIONS: All operations were performed by the same surgeon with the patients under general anesthesia in an outpatient setting. A preformed polyester mesh (Parietex; Covidien, Mansfield, Massachusetts) was used in all cases without any fixation. MAIN OUTCOME MEASURES: All patients were prospectively followed up at 2 weeks, 1 month, and 1 year after surgery. Operative morbidity, chronic pain, and hernia recurrence were recorded. RESULTS: Two hundred seventy-four consecutive patients underwent 311 total extraperitoneal inguinal hernia repairs. No conversions were made to open hernia repairs. No recurrences were found at the 12-month follow-up visit. There were 19 inguinal seromas (6.1%) identified at 2 weeks, but only 7 (1.9%) remained at 1 month, and none at 1 year. No wound infections, scrotal hematomas, or other perioperative complications were reported. Two hundred thirty-six patients used fewer than the 30 prescribed tablets for pain control, while 23 patients requested a refill, 12 of whom had seromas (P < .01). At 12 months, no patient was taking pain relief medication; however, 8 patients reported occasional discomfort in the groin, and 1 patient reported occasional umbilical discomfort. CONCLUSION: This single general surgeon experience supports total extraperitoneal inguinal hernia repair without mesh fixation as a safe, effective procedure with low morbidity and no evidence of recurrence at the 1-year follow-up visit.
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