title: Randomized clinical trial of fixation vs nonfixation of mesh in total extraperitoneal inguinal hernioplasty.
abstract: OBJECTIVE
  Mesh fixation in the extraperitoneal space during endoscopic total extraperitoneal inguinal hernioplasty might be related to an increase in postoperative pain, morbidity rate, and hospital costs.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  From January 1999 to December 2001, 170 patients with inguinal hernia were invited to participate; 85 patients were randomized to each group.
  
  
  METHODS
  Total extraperitoneal inguinal hernioplasty with or without mesh fixation using staples.
  
  
  METHODS
  Operating time, morbidity rate, chronic pain, recurrences, and hospital cost were analyzed. Follow-up was considered complete when it included a physical examination at 24 months (mean, 36 +/- 12 months).
  
  
  RESULTS
  The statistical study showed no significant differences with regard to epidemiological factors, hernia type, operating time, morbidity, or recurrences when the mesh was stapled, although the total cost of the process was higher (P<.001).
  
  
  CONCLUSIONS
  Stapling the mesh in total extraperitoneal inguinal hernioplasty offers no advantages and increases the cost of the process. Our results suggest the possibility of limiting the use of mesh fixation in total extraperitoneal inguinal hernioplasty to cases of direct bilateral hernias.
authors.affiliation: Abdominal Wall Unit, Department of General Surgery, JM Morales Meseguer Hospital, Murcia, Spain. moreno-egea@ono.com
authors.forename: Alfredo
authors.initials: A
authors.lastname: Moreno-Egea
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Torralba Martínez
authors.forename: Germán
authors.initials: G
authors.lastname: Morales Cuenca
authors.forename: José Luis
authors.initials: JL
authors.lastname: Aguayo Albasini
mesh_terms: D003365:Costs and Cost Analysis; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013526:Surgical Mesh / Q000191:economics; D017792:Surgical Stapling / Q000191:economics