title: Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life.
abstract: BACKGROUND
  TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place mesh. Many methods for closure of the PF exist including sutures, tacks, and staples. We hypothesized that patients who had PF closure with suture would have better short-term QOL outcomes.
  
  
  METHODS
  A prospective institutional hernia-specific database was queried for all adult, TAPP IHRs from July 2012 to August 2013. Unilateral and bilateral patients were included and each hernia was analyzed separately. The main outcome of interest was quality of life (QOL) at two- and four-week follow-up, as measured by the Carolinas Comfort Scale.
  
  
  RESULTS
  There were 227 patients who underwent TAPP, with 99 bilateral and 128 unilateral IHR, for a total of 326 IHR. PF closure was performed using tacks in 45.1%, suture in 19.0%, and staples in 35.9%. Patient characteristics were statistically similar between the tack, suture, and staple group. There were 32.9% direct, 46.5% indirect, and 20.6% pantaloon hernias, which were not significantly different when compared by PF closure method. Post-operative complications and length of stay were same for the three groups. There were no hernia recurrences. Post-operative activity limitation at two weeks was significantly better in the suture group when compared to the stapled group (p = 0.005). Additionally, sutured PF closure had less early post-operative pain when compared to the tack group (p = 0.038).
  
  
  CONCLUSIONS
  Following TAPP IHR, suture closure of the PF significantly improves 2-week post-operative movement limitation compared to stapled and tacked PF closure. Continued randomized studies are needed to determine the best surgical hernia repair methods for ideal post-op QOL.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA, samuel.ross@carolinashealthcare.org.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Ross
authors.forename: Bindhu
authors.initials: B
authors.lastname: Oommen
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Walters
authors.forename: Vedra A
authors.initials: VA
authors.lastname: Augenstein
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: B
authors.initials: B
authors.lastname: Todd Heniford
mesh_terms: D005260:Female; D006552:Hernia, Inguinal / Q000523:psychology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D013526:Surgical Mesh; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures