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Surgical Endoscopy

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01-10-2011

Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India

Authors: Pankaj Garg, Srijith Nair, Muhammed Shereef, Jai Deep Thakur, Nikhilesh Nain, Geetha R. Menon, Mohamed Ismail

Published in: Surgical Endoscopy | Issue 10/2011

Abstract

Background

Several studies have shown that nonfixation of mesh in total extraperitoneal (TEP) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation in terms of recurrence rate, pain scores, and other morbidity parameters. The aim of this study was to compare the effect of nonfixation of mesh with fixation in laparoscopic TEP inguinal hernia repair in a rural hospital in India.

Methods

One hundred four patients were randomized to mesh nonfixation group or a fixation group during TEP. The postoperative pain scores on a visual analog scale (VAS) at 24 h, 1 week, 1 month, and 1 year, urinary retention, seroma formation, length of hospital stay, days taken to resume normal activities, and recurrence after 2 years were analyzed. The trial was registered at www.clinicaltrials.gov (ID: NCT01117337).

Results

One hundred four patients (194 hernias) were randomized to mesh nonfixation or fixation. The pain scores at 24 h were comparable (Fix, 1.31 ± 0.4; Nonfix, 1.42 ± 0.5, P = 0.23). The length of hospital stay (Fix, 1.12 ± 0.3 days; Nonfix, 1.15 ± 0.4 days, P = 0.7) and days taken to resume normal activities (Fix, 7.77 ± 1.3 days; Nonfix, 7.96 ± 1.15 days, P = 0.44) were also similar for both groups. The mean pain scores at 1 week (Fix, 1.25 ± 0.5; Nonfix, 1.34 ± 0.6, P = 0.42), 1 month (Fix, 1.06 ± 0.2; Nonfix, 1.17 ± 0.4, P = 0.12), 1 year (Fix, 1.04 ± 0.2; Nonfix, 1.13 ± 0.4, P = 0.11), and 2 years (Fix, 1.03 ± 0.2; Nonfix, 1.0, P = 0.17) were comparable for both groups. There was no recurrence in either group at a minimum follow-up of 2 years.

Conclusions

There was no significant difference between fixation and nonfixation of mesh in TEP inguinal hernia repair with respect to postoperative pain, length of hospital stay, resumption of normal activities, seroma formation, and recurrence rate. Nonfixation of mesh is safe and recommended in TEP inguinal hernia repair when done by an experienced surgeon, even in a rural setting. The study highlights the potential for universal application of the procedure.

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Title: Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India
Authors: Pankaj Garg
Srijith Nair
Muhammed Shereef
Jai Deep Thakur
Nikhilesh Nain
Geetha R. Menon
Mohamed Ismail
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 10/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1708-z

At a glance: The STEP trials

Springer Medicine

Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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