title: Prospective, randomized and controlled study of mesh displacement after laparoscopic inguinal repair: fixation versus no fixation of mesh.
abstract: BACKGROUND
  Repair of inguinal hernia is one of the most common elective operations performed in general surgery practice. Mesh hernia repair became the gold standard because of its low recurrence rate in comparison with non-tension-free repair. Laparoscopic approach seems to have potential advantages over open techniques, including faster recovery and reduced acute and chronic pain rate. Laparoscopic mesh fixation is usually performed using staples, which is associated with higher cost and risk for chronic pain. Recently, the role of mesh fixation has been questioned by several surgeons.
  
  
  OBJECTIVE
  To evaluate mesh displacement in patients undergoing laparoscopic inguinal hernia repair comparing mesh fixation with no fixation.
  
  
  METHODS
  From January 2012 to May 2014, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups: control group--10 patients underwent totally extraperitoneal (TEP) repair with mesh fixation; NO FIX group-50 patients underwent TEP repair with no mesh fixation. Mesh was marked with three 3-mm surgical clips at its medial inferior, medial superior and lateral inferior corners. Mesh displacement was measured by comparing an initial X-ray, performed in the immediate postoperative period, with a second X-ray obtained 30 days later.
  
  
  RESULTS
  The mean displacement of all three clips in control group was 0.1-0.35 cm (range 0-1.2 cm), while in NO FIX group was 0.1-0.3 cm (range 0-1.3 cm). The overall displacement of control and NO FIX group did not show any difference (p = 0.50).
  
  
  CONCLUSIONS
  Fixation of the mesh for TEP repair is unnecessary. TEP repair with no mesh fixation is safe and is not associated with increased risk of mesh displacement.
authors.affiliation: Minimally Invasive Surgery, Positivo University/Jacques Perissat Institute, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, PR, 81280-330, Brazil. christiano.claus@gmail.com.
authors.forename: C M P
authors.initials: CM
authors.lastname: Claus
authors.affiliation: Radiology, Nossa Senhora das Graças Hospital, Curitiba, Brazil.
authors.forename: G M
authors.initials: GM
authors.lastname: Rocha
authors.affiliation: Surgery, Universidade Federal do Parana, Curitiba, Brazil.
authors.forename: A C L
authors.initials: AC
authors.lastname: Campos
authors.affiliation: Minimally Invasive Surgery, Positivo University/Jacques Perissat Institute, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, PR, 81280-330, Brazil.
authors.forename: E A
authors.initials: EA
authors.lastname: Bonin
authors.affiliation: Minimally Invasive Surgery, Positivo University/Jacques Perissat Institute, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, PR, 81280-330, Brazil.
authors.forename: D
authors.initials: D
authors.lastname: Dimbarre
authors.affiliation: Minimally Invasive Surgery, Positivo University/Jacques Perissat Institute, Rua Professor Pedro Viriato Parigot de Souza, 5300, Curitiba, PR, 81280-330, Brazil.
authors.forename: M P
authors.initials: MP
authors.lastname: Loureiro
authors.affiliation: Surgery, Universidade Federal do Parana, Curitiba, Brazil.
authors.forename: J C U
authors.initials: JC
authors.lastname: Coelho
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh / Q000009:adverse effects; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: Inguinal hernia; Laparoscopic; Mesh fixation; TEP