title: Objective hypoesthesia and pain after transabdominal preperitoneal hernioplasty: a prospective, randomized study comparing tissue adhesive versus spiral tacks.
abstract: BACKGROUND
  Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed objectively. We objectively investigated hypoesthesia and chronic pain after transabdominal preperitoneal inguinal hernia repair (TAPP) with titanium spiral tacks (STs) compared with tissue adhesive (TA) for mesh fixation.
  
  
  METHODS
  Mesh fixation in 80 TAPP procedures was randomized to fixation with ST (n = 40) or TA (n = 40). The outcome parameters included hypoesthesia assessed with von Frey monofilaments, early postoperative and chronic pain with the visual analog scale (VAS), morbidity (surgical-site infection, hematoma/seroma, relapse of hernia, trocar hernia), and recovery time to normal activity.
  
  
  RESULTS
  Median (range) follow-up was 38 (13-56) months. Demographic and baseline parameters were similar in the two groups. Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group (6 weeks: 32 vs. 6%; 6 months: 38 vs. 14%; 12 months: 34 vs. 13%; 13-56 months: 32 vs. 4%). Mean hypoesthesia scores over all time points were significantly higher in the ST group. The percentages of regions with hypoesthesia (abdominal, inguinal, or genitofemoral) following all procedures were higher in the ST group after 6 weeks (14 vs. 2%), 6 months (15 vs. 5%), and 13-56 months (22 vs. 4%). The intensity of pain decreased significantly in both groups over time.
  
  
  CONCLUSIONS
  Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling.
authors: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. lukas.bruegger@insel.ch
authors: Lukas
authors: L
authors: Brügger
authors: Martina
authors: M
authors: Bloesch
authors: Ramin
authors: R
authors: Ipaktchi
authors: Anita
authors: A
authors: Kurmann
authors: Daniel
authors: D
authors: Candinas
authors: Guido
authors: G
authors: Beldi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000209:etiology; D003487:Cyanoacrylates / Q000009:adverse effects*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006987:Hypesthesia / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D017792:Surgical Stapling / Q000009:adverse effects*; D014014:Tissue Adhesives / Q000009:adverse effects*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C421460:glubran