Comparison of adhesion formation and tensile strength after three laparoscopic herniorrhaphy techniques

Several techniques for laparoscopic inguinal herniorrhaphy have been described in the literature: laparoscopic extraperitoneal mesh repair (EXTRA), transabdominal preperitoneal mesh repair (TAPP), and intraperitoneal onlay mesh repair (IPOM). To evaluate the incidence of adhesion formation and the tensile properties of these techniques, young male pigs underwent mesh placement using the above techniques. The animals had follow-up for 6 weeks, and no trocar site adhesions were observed. No intraperitoneal adhesions resulted in the group that underwent EXTRA technique. One case of filmy omental adhesions was observed with the TAPP technique, and two cases of adhesions were associated with the IPOM technique, one minimal and one case of dense adhesions to the bladder. The tensile strength of mesh incorporation into abdominal fascia was compared for the three techniques and measured using a tensiometer. The IPOM technique resulted in the weakest tensile strength of 0.53 +/- 0.01 kg (mean +/- SEM), whereas both the EXTRA and TAPP were comparable and significantly stronger (p < 0.05), with tensiometric values of 0.69 +/- 0.03 and 0.60 +/- 0.02 kg, respectively. We concluded that IPOM, although technically the easiest procedure to perform, is associated with the highest risk of adhesion formation and the lowest tensile strength. In comparison, the EXTRA and the TAPP techniques had the advantages of better tissue incorporation and tensile strength. Adhesion formation was not observed with the EXTRA technique, in which the peritoneum was not violated, and was uncommon and minimal with the TAPP technique.