Bilateral laparoscopic totally extraperitoneal repair without mesh fixation

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Hernia Repair

Background:

• Mesh fixation is standard in laparoscopic totally extraperitoneal repair to prevent hernia recurrence.
• Concerns exist that mesh fixation may contribute to increased postoperative chronic pain.

Purpose of the Study:

• To evaluate the outcomes of laparoscopic totally extraperitoneal repair without mesh fixation for inguinal hernias.
• To assess complications, chronic pain, operative time, and recurrence rates in a single-surgeon series.

Main Methods:

• Retrospective review of medical records for patients undergoing bilateral laparoscopic totally extraperitoneal repair without mesh fixation.
• Data collected included demographics, operative details, and postoperative outcomes for 343 patients (686 hernias) from 2005-2011.

Main Results:

• Low rates of intraoperative complications (0.3% conversion, 0.3% bladder injury) and postoperative complications (1.5% hematoma/seroma, 0.3% wound infection).
• Chronic pain occurred in 2.6% of patients, with a 2.9% recurrence rate (5.2% of patients).
• Mean operative time was 33 minutes, with most patients discharged same-day.

Conclusions:

• Laparoscopic totally extraperitoneal repair without mesh fixation is associated with fewer complications and less chronic pain compared to literature.
• A slight increase in recurrence rate was observed, particularly for direct hernias.
• This technique offers a viable alternative with favorable short-term outcomes.