title: Total extraperitoneal laparoscopic inguinal hernia repair without mesh fixation: prospective study with 1-year follow-up results.
abstract: OBJECTIVE
  To determine the outcomes of patients undergoing total extraperitoneal inguinal hernia repair without fixation of the mesh.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Community teaching hospital.
  
  
  METHODS
  A total of 274 consecutive patients were included in the study group.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Rhode Island Hospital, Providence, 02903, USA. emessaris@brown.edu
authors.forename: Evangelos
authors.initials: E
authors.lastname: Messaris
authors.forename: Guy
authors.initials: G
authors.lastname: Nicastri
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Dudrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D049291:Seroma / Q000453:epidemiology; D013526:Surgical Mesh; D055815:Young Adult