title: When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases.
abstract: Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Hernia Registry. In the period September 01, 2009, to January 31, 2014, 11,228 male patients were operated on with the TAPP technique for a primary unilateral inguinal hernia and were followed up for 1 year. Mesh fixation was used for 7422 (66.1 %) of these patients and no mesh fixation for 3806 patients (33.9 %). Unadjusted analysis did not find any significant difference in the recurrence rate (0.88 % with fixation vs. 1.1 % without fixation; p = 0.259). Multivariable analysis of all potential influence factors (age, ASA, BMI, risk factors, defect size, mesh fixation, localization of defect, mesh size) did not identify any factor that impacted recurrence on 1-year follow-up. Only for medial and combined defect localization versus lateral localization was a highly significant effect identified (p < 0.001). With mesh fixation and larger mesh size, it was possible to significantly reduce the recurrence rate for larger medial hernias in this series (p = 0.046). For TAPP repair of an inguinal hernia, mesh fixation is not necessary in a significant number of patients. Patients with a medial and combined hernia are at higher risk of recurrence. In the patient series analyzed, it was possible to significantly reduce the recurrence rate with mesh fixation and larger mesh size for medial defects.
authors.affiliation: Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. f.mayer@salk.at.
authors.forename: F
authors.initials: F
authors.lastname: Mayer
authors.affiliation: Hanse Hernia Center, Hamburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Niebuhr
authors.affiliation: Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Lechner
authors.affiliation: Department of Surgery, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020, Salzburg, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Dinnewitzer
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Köhler
authors.affiliation: StatConsult GmbH, Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hukauf
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital, Vienna, Austria.
authors.forename: R H
authors.initials: RH
authors.lastname: Fortelny
authors.affiliation: Hernia Center, Winghofer Medicum, Rottenburg am Neckar, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bittner
authors.affiliation: Department of Surgery and Center of Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Köckerling
mesh_terms: D000328:Adult; D000368:Aged; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Inguinal hernia; Medial hernia; Mesh fixation; Recurrence; TAPP