A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias.
BACKGROUND
After the first report of laparoscopic incisional and ventral hernia repair (LIVHR) in 1993, several studies have proven its efficacy over open method. Among the technical issues, the technique of mesh fixation to the abdominal wall is still an area of debate. This prospective randomized study was done to compare two techniques of mesh fixation, i.e., tacker with four corner transfascial sutures versus transfascial sutures alone.


METHODS
68 patients admitted for LIVHR repair (defect size less than 25 cm2) were randomized in two groups: group I, tacker fixation (36 patients) and group II, suture fixation (32 patients). Various intraoperative variables and postoperative outcomes were recorded and analyzed.


RESULTS
The patients in the two groups were well matched in terms of age, sex, body mass index (BMI), and hernia characteristics. Mean BMI was 29.0 kg/m2. Operative time was found to be significantly higher in group II (77.5 versus 52.6 min, p=0.000). Patients in group I were found to have significantly higher pain scores at 1 h, 6 h, 24 h, 1 week, 1 month, and 3 months postoperatively. At follow-up, incidence of seromas was higher in group II but the difference was not significant (7 versus 4, p=0.219). During long-term follow-up, patients in group II were satisfied cosmetically.


CONCLUSIONS
Suture fixation is a cost-effective alternative to tacker fixation, for small and medium-sized defects in anatomically accessible areas. However, suture fixation requires significantly longer operation time, but patients have statistically significantly less postoperative pain.
Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, Room No. 5021, 5th Floor, Teaching Block, New Delhi, India. drvkbansal@gmail.com
Virinder Kumar
VK
Bansal
Mahesh C
MC
Misra
Subodh
S
Kumar
Y Keerthi
YK
Rao
Paras
P
Singhal
Amit
A
Goswami
Sandeep
S
Guleria
M K
MK
Arora
Anjolie
A
Chabra
D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000191:economics / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D012008:Recurrence; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh / Q000191:economics; D013530:Surgical Wound Infection; D013536:Suture Techniques; D055815:Young Adult
D011126:Polypropylenes; D011138:Polytetrafluoroethylene