Laparoscopic totally extraperitoneal repair of inguinal hernia: a policy of selective mesh fixation over a 10-year period.
BACKGROUND
The issue of mesh fixation in laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia repairs remains unresolved. The need for fixing the mesh arises from the fear of increasing recurrence rates. However, specific complications have emerged as a result of mesh fixation.


METHODS
A retrospective analysis of 822 laparoscopic TEP hernia repairs in 634 patients over a 10-year period in a single surgical unit was performed. A policy of selective mesh fixation was followed and guidelines regarding indications of mesh fixation formulated. Recurrence rates and complications specific to mesh fixation were evaluated.


RESULTS
Mesh was fixed in only 28 of 822 repairs. There were 6 (0.7%) recurrences. No neuropathic or mesh-fixation-related complications were noted in a follow-up period ranging from 10 to 82 months.


CONCLUSIONS
Avoiding routine fixation of the mesh helps in decreasing complications and operative costs with acceptable recurrence rates. However, a policy of selective mesh fixation is advocated, based on specific indications.
Saggar
Vishal R
VR
Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Sarangi
Rathindra
R
D000328:Adult; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D012008:Recurrence; D013526:Surgical Mesh