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Updated: Aug 29, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Investigating a possible cause of mesh migration during totally extraperitoneal (TEP) repair
1Department of Surgery, Staten Island University Hospital, 65 Cromwell Avenue, Staten Island, NY 10304, USA.
Background:
In experienced hands, laparoscopic inguinal hernia repair has a low rate of recurrence, but it still can recur, and a number of reasons for this have been identified. In published studies, the majority of such cases seem to result from inadequate dissection leading to missed hernias or suboptimal mesh placement. But even with adequate dissection and proper placement of a sufficiently large mesh, recurrence sometimes happens. A number of investigators have cited mesh migration or dislocation as a possible cause, and this study examined how hip flexion affects the position of newly placed meshes and staples in totally extraperitoneal (TEP) repair of inguinal hernia.
Methods:
After completion of the dissection and reduction of discovered hernias, a 15 x 15-cm polypropylene mesh was placed either unilaterally or bilaterally, as indicated. The preperitoneal space then was desufflated. The operating table, in an extended -20 degrees position during surgery, was placed in a 90 degrees position for approximately 15 s. After reinsufflation, the possibility of mesh migration and folding was investigated. Finally, the mesh was stapled, the table again extended and flexed, and the possibility of mesh migration and staple dislodgement investigated once more.
Results:
The mesh did not migrate or become displaced from any potential hernia area, nor did any of the staples become dislodged.
Conclusions:
Concern about mesh migration attributable to patients sitting up immediately after surgery appears to be unfounded, at least according to the findings for the current, small, simulated study group.
Insights
Immediate post-surgery hip flexion does not cause mesh migration or staple dislodgement in totally extraperitoneal (TEP) inguinal hernia repair. This study suggests concerns about early patient mobilization are unfounded for mesh and staple security.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Hernia Repair
Background:
- Laparoscopic inguinal hernia repair, while effective, can still recur due to factors like inadequate dissection or suboptimal mesh placement.
- Mesh migration or dislocation is a suspected cause of recurrence even with proper surgical technique.
- This study investigates the impact of hip flexion on mesh and staple positioning after TEP repair.
Purpose of the Study:
- To evaluate the effect of immediate post-operative hip flexion on mesh and staple stability.
- To address concerns regarding mesh migration after totally extraperitoneal (TEP) inguinal hernia repair.
Main Methods:
- Polypropylene mesh (15x15 cm) was placed in the preperitoneal space during TEP repair.
- The operating table was flexed to 90 degrees for 15 seconds after mesh placement and desufflation.
- Mesh migration, folding, and staple dislodgement were assessed after table flexion and re-extension.
Main Results:
- No instances of mesh migration or displacement were observed.
- No staple dislodgement occurred during the simulated post-operative hip flexion maneuvers.
- The polypropylene mesh and fixation staples remained stable throughout the tested range of motion.
Conclusions:
- Concerns regarding mesh migration due to immediate post-operative patient sitting appear unfounded based on this study.
- The findings suggest that early mobilization involving hip flexion is unlikely to compromise mesh or staple placement in TEP hernia repair.
- Further research with larger sample sizes is warranted to confirm these preliminary findings.