title: Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India.
abstract: BACKGROUND
  Several studies have shown that nonfixation of mesh in total extraperitoneal (TEP) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation in terms of recurrence rate, pain scores, and other morbidity parameters. The aim of this study was to compare the effect of nonfixation of mesh with fixation in laparoscopic TEP inguinal hernia repair in a rural hospital in India.
  
  
  METHODS
  One hundred four patients were randomized to mesh nonfixation group or a fixation group during TEP. The postoperative pain scores on a visual analog scale (VAS) at 24 h, 1 week, 1 month, and 1 year, urinary retention, seroma formation, length of hospital stay, days taken to resume normal activities, and recurrence after 2 years were analyzed. The trial was registered at www.clinicaltrials.gov (ID: NCT01117337).
  
  
  RESULTS
  One hundred four patients (194 hernias) were randomized to mesh nonfixation or fixation. The pain scores at 24 h were comparable (Fix, 1.31 ± 0.4; Nonfix, 1.42 ± 0.5, P = 0.23). The length of hospital stay (Fix, 1.12 ± 0.3 days; Nonfix, 1.15 ± 0.4 days, P = 0.7) and days taken to resume normal activities (Fix, 7.77 ± 1.3 days; Nonfix, 7.96 ± 1.15 days, P = 0.44) were also similar for both groups. The mean pain scores at 1 week (Fix, 1.25 ± 0.5; Nonfix, 1.34 ± 0.6, P = 0.42), 1 month (Fix, 1.06 ± 0.2; Nonfix, 1.17 ± 0.4, P = 0.12), 1 year (Fix, 1.04 ± 0.2; Nonfix, 1.13 ± 0.4, P = 0.11), and 2 years (Fix, 1.03 ± 0.2; Nonfix, 1.0, P = 0.17) were comparable for both groups. There was no recurrence in either group at a minimum follow-up of 2 years.
  
  
  CONCLUSIONS
  There was no significant difference between fixation and nonfixation of mesh in TEP inguinal hernia repair with respect to postoperative pain, length of hospital stay, resumption of normal activities, seroma formation, and recurrence rate. Nonfixation of mesh is safe and recommended in TEP inguinal hernia repair when done by an experienced surgeon, even in a rural setting. The study highlights the potential for universal application of the procedure.
authors.affiliation: Department of General Surgery, MM Institute of Medical Sciences & Research, Mullana, Haryana, India. drgargpankaj@yahoo.com
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.forename: Srijith
authors.initials: S
authors.lastname: Nair
authors.forename: Muhammed
authors.initials: M
authors.lastname: Shereef
authors.forename: Jai Deep
authors.initials: JD
authors.lastname: Thakur
authors.forename: Nikhilesh
authors.initials: N
authors.lastname: Nain
authors.forename: Geetha R
authors.initials: GR
authors.lastname: Menon
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ismail
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007194:India / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012424:Rural Population; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D016896:Treatment Outcome