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Laparoscopic inguinal hernia repair using an anatomically contoured three-dimensional mesh.

R C W Bell1, J G Price

  • 1Department of Surgery, Swedish Medical Center, 499 East Hampden Suite 450, Englewood, CO 80110, USA. rbell@surgone.com

Surgical Endoscopy
|September 6, 2003
PubMed
Summary

Anatomically contoured mesh for laparoscopic inguinal hernia repair often requires no fixation, reducing pain and complications. This method shows excellent recovery rates and a low recurrence risk, making it a safe and effective surgical option.

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Area of Science:

  • Surgical Innovation
  • Minimally Invasive Surgery
  • Hernia Repair Techniques

Background:

  • Laparoscopic inguinal hernia repair commonly uses mechanical fixation for flat polypropylene mesh.
  • Mechanical fixation is linked to pain syndromes and potential mesh migration.
  • An anatomically contoured mesh may overcome these limitations with reduced fixation.

Purpose of the Study:

  • To evaluate the efficacy and safety of an anatomically contoured mesh (3D Max) in transabdominal preperitoneal (TAPP) hernia repair.
  • To assess the necessity of mesh fixation and its impact on patient recovery and recurrence rates.

Main Methods:

  • Retrospective case study of 212 TAPP herniaplasties using 11 x 16-cm 3D Max mesh in 146 patients.
  • Minimal fixation (three helical tacks) was used selectively for very large defects or early in the study.

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  • Data collected on patient recovery, complications, and hernia recurrence.

    • Main Results:

    • Mesh fixation was used in only 19% of cases, with significantly less use in later cases.
    • 94% of patients returned to normal activities within 3 weeks; 97% resumed unrestricted sports by 6 weeks.
    • Zero symptomatic recurrences were observed; one asymptomatic recurrence yielded a 0.42% patient-year recurrence risk.

    Conclusions:

    • Anatomically contoured mesh in TAPP hernia repair often necessitates no fixation, minimizing neuropathy risk.
    • Excellent recovery and a low recurrence rate (<0.5% patient-year) are achievable.
    • The technique is safe and effective, even with bilateral repairs or occasional fixation.