title: Selective non-stapling of mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty: a case-control study.
abstract: OBJECTIVE
  Selective non-stapling of the mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty (TEP) may reduce postoperative pain and morbidity rate.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Division of general surgery at a university-affiliated teaching hospital.
  
  
  METHODS
  Two hundred patients who underwent TEP.
  
  
  METHODS
  Endoscopic total extraperitoneal inguinal hernioplasty with and without stapling the mesh. The mesh was stapled when the diameter of the hernial defect was greater than 4 cm or there was an inadequate overlap of the defect by the mesh.
  
  
  METHODS
  Postoperative pain score and morbidity rate were compared between patients who had stapling and selective non-stapling of the mesh during TEP.
  
  
  RESULTS
  Demographic features, hernia types, and mean operative times of the 2 groups were comparable. Postoperative pain scores upon coughing from the day of operation to postoperative day 6 were lower in patients who had not had the mesh stapled, but the difference was not statistically significant. Comparisons of the mean length of hospital stay, postoperative morbidity, and time taken to resume normal activities showed no significant difference between the 2 groups. With a mean follow-up of 1 year, no neuralgia or recurrence was noted in either group during follow-up.
  
  
  CONCLUSIONS
  Selective non-stapling of the mesh did not confer short-term benefits, such as reduced postoperative pain and morbidity, compared with those who had routine stapling of the mesh during TEP. For patients with a hernial defect measuring less than 4 cm, TEP can be performed without stapling the mesh. The selective non-stapling strategy also helps to reduce the cost of the operation and the potential for nerve entrapment.
authors.affiliation: Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, Sheung Wan, Hong Kong, China. lauh@hkucc.hku.hk
authors.forename: Hung
authors.initials: H
authors.lastname: Lau
authors.forename: Nivritti G
authors.initials: NG
authors.lastname: Patil
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D013526:Surgical Mesh; D013537:Sutures / Q000706:statistics & numerical data*; D016896:Treatment Outcome