title: Impact of the number of tacks on postoperative pain in laparoscopic repair of ventral hernias: do more tacks cause more pain?
abstract: BACKGROUND
  The main source of postoperative pain after laparoscopic repair of ventral hernia is thought to be fixation of implanted mesh. This study aimed to analyze whether a relation exists between the number of tacks used for fixation and postoperative pain.
  
  
  METHODS
  To reduce the number of prognostic variables, only patients with primary umbilical hernia who underwent laparoscopic repair with double-crown mesh fixation were enrolled in this study. Two groups differing only in the manner of tacking were compared. Group 1 (n = 40), collected from previous studies, showed no specific efforts to minimize the number of tacks. Group 2 was a cohort of 40 new patients who underwent double-crown fixation using the minimal number of tacks considered to provide adequate mesh fixation. To eliminate systematic and random errors, the study analyzed only for postoperative pain. The severity of the patients' pain was assessed preoperatively and then 2, 6, and 12 weeks postoperatively using a visual analog scale (VAS) ranging from 0 to 100.
  
  
  RESULTS
  The mean number of tacks used differed significantly between the two groups: group 1 (45.4 ± 9.6) vs group 2 (20.4 ± 1.4) (p = 0.001). Postoperative pain differed significantly only at the 3-month postoperative assessment: group 1 VAS (5.78) vs group 2 VAS (1.80) (p = 0.002).
  
  
  CONCLUSIONS
  Although postoperative pain differed significantly at the 3-month follow-up assessment, both VAS scores were so low that from a clinical point of view, this difference seems irrelevant. Fewer tacks do not create less pain, nor do more tacks create more pain. This absence of a correlation between the number of tacks used and postoperative pain may indicate that pain after laparoscopic repair of at least small ventral hernias possibly is generated according to some "threshold" principle rather than according to a cumulative effect created by more points of fixation.
authors: Department of Surgery, ZGT Hospital, Jan Ligthartplein 51, 3706 VE, Zeist, Almelo, The Netherlands. eschoenmaeckers@gmail.com
authors: Ernst J P
authors: EJ
authors: Schoenmaeckers
authors: Robert J
authors: RJ
authors: de Haas
authors: Vincent
authors: V
authors: Stirler
authors: Johan T F J
authors: JT
authors: Raymakers
authors: Srdjan
authors: S
authors: Rakic
mesh_terms: D000328:Adult; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D013525:Surgical Instruments / Q000009:adverse effects* / Q000706:statistics & numerical data; D013526:Surgical Mesh