title: Slit versus non-slit mesh placement in total extraperitoneal inguinal hernia repair.
abstract: BACKGROUND
  The goal of the present research was to study patients who underwent laparoscopic total extraperitoneal repair using slit and non-slit mesh placement.
  
  
  METHODS
  Patients who underwent laparoscopic inguinal hernia repair in our hospital between 2005 and 2009 were interviewed and examined. Surgery outcome, hernia recurrence, postoperative pain and time to return to normal physical activities, and surgery satisfaction were compared.
  
  
  RESULTS
  During the study period 389 consecutive patients underwent laparoscopic groin hernia repair: 387 by the total extraperitoneal (TEP) approach and 2 by the TAPP approach. Six of the TEP patients were converted to TAPP. Eighty-seven patients in the TEP group had slit mesh placement and 300 had non-slit mesh placement. Mean follow-up was 36 months (range: 6-66 months). At follow-up, 387 patients responded to a request for interview and 277 were examined. The overall recurrence rate was 4.7%, the incidence of constant postoperative pain was 1.3%, the presence of permanent testicular pain was 2.8%, and patient satisfaction with the surgery was 94.5%. A significantly lower recurrence rate was found in the slit mesh group than in the non-slit group (0.6% versus 5.9%; p < 0.003). There was no difference in the length of time until return to normal activities, patient satisfaction, and postoperative pain between the groups. Surgery time and the occurrence of testicular pain were significantly greater in the anatomic group.
  
  
  CONCLUSIONS
  Total extraperitoneal inguinal hernia repair with slit mesh placement is a safe technique with a very low recurrence rate and is superior to non-slit mesh positioning.
authors.affiliation: Department of Surgery "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Domniz
authors.forename: Zvi Howard
authors.initials: ZH
authors.lastname: Perry
authors.forename: Leonid
authors.initials: L
authors.lastname: Lantsberg
authors.forename: Eliezer
authors.initials: E
authors.lastname: Avinoach
authors.forename: Solly
authors.initials: S
authors.lastname: Mizrahi
authors.forename: Boris
authors.initials: B
authors.lastname: Kirshtein
mesh_terms: D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D020127:Recovery of Function; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome