title: Self-gripping mesh versus staple fixation in laparoscopic inguinal hernia repair: a prospective comparison.
abstract: BACKGROUND
  Transabdominal preperitoneal (TAPP) repair is widely used to treat bilateral or recurrent inguinal hernias. Recently a self-gripping mesh has been introduced into clinical practice. This mesh does not need staple fixation and thus might reduce the incidence of chronic pain. This prospective study aimed to compare two groups of patients with bilateral (BIH) or monolateral (MIH) primary or recurrent inguinal hernia treated with TAPP using either a self-gripping polyester and polylactic acid mesh (SGM) or a polypropylene and poliglecaprone mesh fixed with four titanium staples [standard technique (ST)].
  
  
  METHODS
  In this study, 96 patients (mean age, 58 years) with BIH (73 patients with primary and recurrent hernia) or MIH (22 patients with recurrent hernia) underwent a TAPP repair. For 49 patients, the repairs used SGM, and for 46 patients, ST was used. The patients were clinically evaluated 1 week and then 30 days postoperatively. After at least 6 months, a phone interview was conducted. The short-form McGill Pain Questionnaire was administered to all the patients at the 6-month follow-up visit.
  
  
  RESULTS
  The mean length of the procedure was 83 min in the SGM group and 77.5 min in the ST group. The mean follow-up period was 13.8 months (range 1.3-42.0 months) for the SGM group and 18.2 months (range 1.9-27.1 months) for the ST group. The recurrence rate at the last follow-up visit was 0 % in the SGM group and 2.2 % (1 patient) in the ST group. The incidence of mild chronic pain at the 6-month follow-up visit was 4.1 % in the SGM group and 9.1 % in the ST group, and the incidence of moderate or severe pain was respectively 2.1 and 6.8 %.
  
  
  CONCLUSIONS
  The study population was not large enough to obtain statistically significant results. However, the use of SGM for TAPP repairs appeared to give good results in terms of chronic pain, and the incidence of recurrences was not higher than with ST. In our unit, SGM during TAPP repair of inguinal hernias has become the standard.
authors.affiliation: General and Minimally Invasive Surgery, Istituto Clinico Humanitas IRCCS, Via Manzoni, 56, 20089 Rozzano, Milan, Italy. uberto.fumagalli@humanitas.it
authors.forename: Uberto
authors.initials: U
authors.lastname: Fumagalli Romario
authors.forename: Francesco
authors.initials: F
authors.lastname: Puccetti
authors.forename: Ugo
authors.initials: U
authors.lastname: Elmore
authors.forename: Simonetta
authors.initials: S
authors.lastname: Massaron
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
mesh_terms: D000328:Adult; D000368:Aged; D004146:Dioxanes; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015994:Incidence; D019344:Lactic Acid; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology; D011091:Polyesters; D011108:Polymers; D011126:Polypropylenes; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D017792:Surgical Stapling; D016896:Treatment Outcome
chemical_list: D004146:Dioxanes; D011091:Polyesters; D011108:Polymers; D011126:Polypropylenes; D019344:Lactic Acid; C095495:glycolide E-caprolactone copolymer; C033616:poly(lactide)