Transabdominal pre-peritoneal inguinal hernia repair with external fixation

To find a method that has all the advantages of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair but with considerably reduced costs.

Controversy exits regarding whether it is necessary to secure the mesh prosthesis during laparoscopic TAPP inguinal hernia repair. It is unknown whether stapling the mesh affects recurrence rate or the incidence of neuralgia in a port-site hernia. We choose to fix the mesh to the exterior, thus reducing port size, cost and pain.

We conducted a prospective trial for laparoscopic TAPP inguinal hernia repair in which we fixed the mesh to the anterior abdominal wall using two prolene threads that passed to the exterior and were tied in place. The study was conducted at Al Hayat Hospital Jeddah, Saudi Arabia, between September 2008 and April 2009. Included in the study were 42 patients with unilateral inguinal hernia.

The operative time ranged from 35 to 85 min and follow up was for 9-16 months, during which time there was no recurrence, no post TAPP pain. The procedure reduces the port size required and was also associated with reduced cost.

It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair from the interior. External fixation allows a reduction in size of the ports needed, and leads to a considerable reduction in cost.