title: Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh.
abstract: BACKGROUND
  Fixation of the mesh during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative pain and lead to an increased risk of complications. We questioned whether elimination of fixation of the mesh during TEP inguinal hernia repair leads to decreased postoperative pain or complications, or both, without an increased rate of recurrence.
  
  
  METHODS
  A randomized prospective single-blinded study was carried out in 40 patients who underwent laparoscopic TEP inguinal hernia repair with (Group A=20) or without (Group B=20) fixation of the mesh.
  
  
  RESULTS
  Patients in whom the mesh was not fixed had shorter hospital length of stay (8.3 vs 16.0 hours, P=0.01), were less likely to be admitted to the hospital (P=0.001), used less postoperative narcotic analgesia in the PACU (P=0.01), and were less likely to develop urinary retention (P=0.04). No significant differences occurred in the level of pain, time to return to normal activity, or the difficulty of the operation between the 2 groups. No hernia recurrences were observed in either group (follow-up range, 6 to 30 months, median=19).
  
  
  CONCLUSIONS
  Elimination of tack fixation of mesh during laparoscopic TEP inguinal hernia repair significantly reduces the use of postoperative narcotic analgesia, hospital length of stay, and the development of postoperative urinary retention but does not lead to a significant reduction in postoperative pain. Eliminating tacks does not lead to an increased rate of recurrence.
authors.affiliation: Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Cody A
authors.initials: CA
authors.lastname: Koch
authors.forename: Susan M
authors.initials: SM
authors.lastname: Greenlee
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harrington
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D016009:Chi-Square Distribution; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D020127:Recovery of Function; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D000700:Analgesics