Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation

Christiano Marlo Paggi Claus, Gabriela Moreira Rocha, Antonio Carlos Ligocki Campos, João Augusto Nocera Paulin, Julio Cesar Uili Coelho, Christiano Marlo Paggi Claus, Gabriela Moreira Rocha, Antonio Carlos Ligocki Campos, João Augusto Nocera Paulin, Julio Cesar Uili Coelho

Abstract

Background and objectives: About 20% of patients with inguinal hernia present bilateral hernias in the diagnosis. In these cases, laparoscopic procedure is considered gold standard approach. Mesh fixation is considered important step toward avoiding recurrence. However, because of cost and risk of pain, real need for mesh fixation has been debated. For bilateral inguinal hernias, there are few specific data about non fixation and mesh displacement. We assessed mesh movement in patients who had undergone laparoscopic bilateral inguinal hernia repair without mesh fixation and compared the results with those obtained in patients with unilateral hernia.

Methods: From January 2012 through May 2014, 20 consecutive patients with bilateral inguinal hernia underwent TEP repair with no mesh fixation. Results were compared with 50 consecutive patients with unilateral inguinal hernia surgically repaired with similar technique. Mesh was marked with 3 clips. Mesh movements were measured by comparing initial radiography performed at the end of surgery, with a second radiographic scan performed 30 days later.

Results: Mean movements of all 3 clips in bilateral nonfixation (NF) group were 0.15-0.4 cm compared with 0.1-0.3 cm in unilateral NF group. Overall displacement of bilateral and unilateral NF groups did not show significant difference. Mean overall displacement was 1.9 cm versus 1.8 cm in the bilateral and unilateral NF groups, respectively (P = .78).

Conclusions: TEP with no mesh fixation is safe in bilateral inguinal repairs. Early mesh displacement is minimal. This technique can be safely used in most patients with inguinal hernia.

Keywords: Bilateral inguinal hernia; Inguinal hernia; Laparoscopy; Mesh fixation; Total extraperitoneal.

Figures

Figure 1.
Figure 1.
Mesh positioning and clips placed in one of the meshes. The indicators x and y represent the distances of the clips relative to the vertical and horizontal axes, respectively. Medical illustration by Rodrigo Tonan.
Figure 2.
Figure 2.
Pelvic radiograph showing the clips and performed measures, x and y in relation to the vertical and horizontal axes, respectively.
Figure 3.
Figure 3.
Overall mesh displacement (mean displacement, 1.9 cm vs 1.8 cm in the bilateral NF group and unilateral NF group, respectively. P = 0.78, unilateral group vs. bilateral group, by the Mann-Whitney test.

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