Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation.
BACKGROUND
Mesh fixation during laparoscopic ventral hernia repair can be performed using transfascial sutures or metal tacks. The aim of the present study is to compare mesh shrinkage and pain between two different techniques of mesh fixation in a prospective randomized trial.


METHODS
A randomized trial was performed. Patients with ventral hernia of maximal diameter 8 cm were assigned to mesh fixation using either transfascial nonabsorbable sutures or metal tacks for fixation of a parietene composite mesh. The borders of the mesh were marked using clips, and radiological images in prone position were used for assessment of mesh size and location. The primary endpoint was mesh shrinkage; secondary endpoints included postoperative pain, mesh dislocation, and surgical morbidity.


RESULTS
Demographic parameters were similar in both groups. A total of 40 patients were randomized, and 36 patients were available for follow-up. There was one hernia recurrence in each group. Pain was significantly higher following suture fixation after 6 weeks, but no difference was found after 6 months. Mesh shrinkage after 6 months was significantly higher using tacks for mesh fixation.


CONCLUSIONS
Transfascial sutures are associated with more pain within the first 6 postoperative weeks and less mesh shrinkage after 6 months compared with mesh fixation using metal tacks.
Beldi
Guido
G
Department of Visceral Surgery and Medicine, University of Bern, 3010, Bern, Switzerland. guido.beldi@insel.ch
Wagner
Markus
M
Bruegger
Lukas E
LE
Kurmann
Anita
A
Candinas
Daniel
D
D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D004868:Equipment Failure; D005205:Fascia; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D013526:Surgical Mesh; D013537:Sutures