title: Comparison of mesh fixation and non-fixation in laparoscopic totally extraperitoneal inguinal hernia repair.
abstract: The purpose of this study was to compare laparoscopic total extraperitoneal (TEP) hernia repair procedures with or without mesh fixation for non-recurrent inguinal hernia.
  
  
  
  100 male patients with non-recurrent inguinal hernia (62 unilateral and 38 bilateral) were included in the study. The patients were randomly assigned to either the mesh fixation group (n = 50) or the mesh non-fixation group (n = 50). The operative and follow-up data of the two groups were analyzed and compared in terms of recurrence rates, postoperative pain, length of hospital stay, and postoperative changes in testicular arterial blood flow.
  
  
  
  Pain scores were significantly higher in the mesh fixation group prior to discharge and at the 1st postoperative month (p = 0.034 and 0.001, respectively). Necessity to use narcotic analgesics was higher in the fixation group prior to discharge (p = 0.025). Urinary retention was significantly more frequent in the fixation group than in the non-fixation group. (p = 0.007). The mean operative time and length of hospital stay were similar in both groups. Preoperative and postoperative measurements of testicular arterial blood flow showed a substantial but not statistically significant difference for the frequency of impairment (14.2% in the fixation group and 5.8% in the non-fixation group) (p = 0.176). At long-term follow-up, no recurrence and no nerve injury were determined.
  
  
  
  Fixation of the mesh to the abdominal wall has been associated with various postoperative complications for no additional benefit in lowering recurrence rates. For non-recurrent inguinal hernia, non-fixation of the mesh is safe and reliable. Further studies with larger sample sizes are necessary for subgroup analyses.
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey. op_dr_kenan@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Buyukasik
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Ari
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Akce
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Tatar
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Segmen
authors.affiliation: Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Bektas
mesh_terms: D000328:Adult; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology*; D012008:Recurrence; D013526:Surgical Mesh; D016055:Urinary Retention / Q000453:epidemiology*; D055815:Young Adult
keywords: Inguinal hernia; Mesh fixation; Postoperative pain; Recurrence; Testicular blood flow; Total extraperitoneal repair