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Updated: Mar 7, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Comparison of mesh fixation and non-fixation in laparoscopic totally extraperitoneal inguinal hernia repair
K Buyukasik1, A Ari2, B Akce2
1Department of General Surgery, Istanbul Training and Research Hospital, 34029, Fatih, Istanbul, Turkey. op_dr_kenan@hotmail.com.
Insights
For non-recurrent inguinal hernias, mesh fixation during laparoscopic total extraperitoneal (TEP) repair increases postoperative pain and urinary retention without reducing recurrence. Non-fixation is a safe and effective alternative.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Hernia Repair
Background:
- Inguinal hernias are common surgical conditions.
- Laparoscopic total extraperitoneal (TEP) repair is a minimally invasive approach.
- Mesh fixation is a debated aspect of TEP repair.
Purpose of the Study:
- To compare laparoscopic TEP hernia repair with and without mesh fixation.
- To evaluate outcomes for non-recurrent inguinal hernias.
Main Methods:
- 100 male patients with non-recurrent inguinal hernias were randomized into mesh fixation (n=50) or non-fixation (n=50) groups.
- Data analyzed included recurrence rates, postoperative pain, hospital stay, and testicular arterial blood flow.
- Long-term follow-up was conducted.
Main Results:
- Mesh fixation group reported significantly higher pain scores and increased need for analgesics.
- Urinary retention was more frequent in the mesh fixation group.
- No significant difference in recurrence rates, operative time, or hospital stay; testicular blood flow impairment was not statistically significant.
Conclusions:
- Mesh fixation in TEP repair for non-recurrent inguinal hernias is associated with increased complications without added benefit.
- Non-fixation of mesh is a safe and reliable method for TEP inguinal hernia repair.
- Further research with larger cohorts is recommended for subgroup analysis.
Purpose:
The purpose of this study was to compare laparoscopic total extraperitoneal (TEP) hernia repair procedures with or without mesh fixation for non-recurrent inguinal hernia.
Methods:
100 male patients with non-recurrent inguinal hernia (62 unilateral and 38 bilateral) were included in the study. The patients were randomly assigned to either the mesh fixation group (n = 50) or the mesh non-fixation group (n = 50). The operative and follow-up data of the two groups were analyzed and compared in terms of recurrence rates, postoperative pain, length of hospital stay, and postoperative changes in testicular arterial blood flow.
Results:
Pain scores were significantly higher in the mesh fixation group prior to discharge and at the 1st postoperative month (p = 0.034 and 0.001, respectively). Necessity to use narcotic analgesics was higher in the fixation group prior to discharge (p = 0.025). Urinary retention was significantly more frequent in the fixation group than in the non-fixation group. (p = 0.007). The mean operative time and length of hospital stay were similar in both groups. Preoperative and postoperative measurements of testicular arterial blood flow showed a substantial but not statistically significant difference for the frequency of impairment (14.2% in the fixation group and 5.8% in the non-fixation group) (p = 0.176). At long-term follow-up, no recurrence and no nerve injury were determined.
Conclusion:
Fixation of the mesh to the abdominal wall has been associated with various postoperative complications for no additional benefit in lowering recurrence rates. For non-recurrent inguinal hernia, non-fixation of the mesh is safe and reliable. Further studies with larger sample sizes are necessary for subgroup analyses.
