When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases

F Mayer, H Niebuhr, M Lechner, A Dinnewitzer, G Köhler, M Hukauf, R H Fortelny, R Bittner, F Köckerling, F Mayer, H Niebuhr, M Lechner, A Dinnewitzer, G Köhler, M Hukauf, R H Fortelny, R Bittner, F Köckerling

Abstract

Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Hernia Registry. In the period September 01, 2009, to January 31, 2014, 11,228 male patients were operated on with the TAPP technique for a primary unilateral inguinal hernia and were followed up for 1 year. Mesh fixation was used for 7422 (66.1 %) of these patients and no mesh fixation for 3806 patients (33.9 %). Unadjusted analysis did not find any significant difference in the recurrence rate (0.88 % with fixation vs. 1.1 % without fixation; p = 0.259). Multivariable analysis of all potential influence factors (age, ASA, BMI, risk factors, defect size, mesh fixation, localization of defect, mesh size) did not identify any factor that impacted recurrence on 1-year follow-up. Only for medial and combined defect localization versus lateral localization was a highly significant effect identified (p < 0.001). With mesh fixation and larger mesh size, it was possible to significantly reduce the recurrence rate for larger medial hernias in this series (p = 0.046). For TAPP repair of an inguinal hernia, mesh fixation is not necessary in a significant number of patients. Patients with a medial and combined hernia are at higher risk of recurrence. In the patient series analyzed, it was possible to significantly reduce the recurrence rate with mesh fixation and larger mesh size for medial defects.

Keywords: Inguinal hernia; Medial hernia; Mesh fixation; Recurrence; TAPP.

References

    1. Bittner R, Leibl BJ, Jöger C, Kraft B, Ulrich M, Schwarz J. TAPP-Stuttgart technique and result of a large single center series. J Minim Access Surg. 2006;2(3):155–159. doi: 10.4103/0972-9941.27730.
    1. Bittner R, Gmähle E, Gmühle B, Schwarz J, Aasvang E, Kehlet H. Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP) Surg Endosc. 2010;24(12):2958–2964. doi: 10.1007/s00464-010-1140-9.
    1. Fortelny RH, Petter-Puchner AH, May C, Jaksch W, Benesch T, Khakpour Z, Redl H, Glaser KS. The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life: results of a randomized controlled study. Surg Endosc. 2012;26(1):249–254. doi: 10.1007/s00464-011-1862-3.
    1. Lau H. Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg. 2005;242:670–675. doi: 10.1097/.
    1. Olmi S, Scaini A, Erba L, Guaglio M, Groce E. Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prothesis fixation systems. Surgery. 2007;142:40–46. doi: 10.1016/j.surg.2007.02.013.
    1. Lovisetto F, Zonta S, Rota E, Mazzilli M, Bardone M, Bottero L, Faillace G, Longoni M. Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg. 2007;245:222–231. doi: 10.1097/01.sla.0000245832.59478.c6.
    1. Tam KW, Liang Hung-Hua, Chai Chiah-Yang. Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg. 2010;34(12):3065–3074. doi: 10.1007/s00268-010-0760-5.
    1. Koch CA, Greenlee SM, Larson DR, Harrington JR, Farley DR. Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. JSLS. 2006;10:457–460.
    1. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Paß C, Singh K, Timoney M, Weyhe D, Chowbey P. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)] Surg Endosc. 2011;25:2773–2843. doi: 10.1007/s00464-011-1799-6.
    1. Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Koeckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society) Surg Endosc. 2015;29:289–321. doi: 10.1007/s00464-014-3917-8.
    1. Stechemesser B, Jacob DA, Schug-Paß C, Köckerling F. Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia. 2012;16(3):269–276. doi: 10.1007/s10029-012-0908-3.
    1. Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kongsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB. The European hernia society groin hernia classification: simple and easy to remember. Hernia. 2007;11(2):113–116. doi: 10.1007/s10029-007-0198-3.
    1. Smith AI, Royston CM, Sedman PC. Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a prospective randomized trial. Surg Endosc. 1999;13:804–806. doi: 10.1007/s004649901104.
    1. Burcharth J, Pommergaard HC, Bisgaard T, Rosenberg J. Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies. Surg Innov. 2015;22(3):303–317. doi: 10.1177/1553350614552731.
    1. Lau H, Lee F. Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc. 2003;17:1773–1777. doi: 10.1007/s00464-002-8771-4.
    1. Reddy VM, Sutton CD, Bloxham L, Garcea G, Ubhi SS, Robertson GS. Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma. Hernia. 2007;11:393–396. doi: 10.1007/s10029-007-0233-4.
    1. Choi YY, Kim Z, Hur KY. Sewlling after laparoscopic total extraperitoneal repair of inguinal hernias: review of one surgeon’s experience in 1,065 cases. World J Surg. 2011;35:43–46. doi: 10.1007/s00268-010-0843-3.
    1. Berney CR. The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach. Hernia. 2012;16:301–305. doi: 10.1007/s10029-011-0892-z.
    1. Köckerling F, Jacob DA, Lomanto D, Chowbey P. C. R. Berny: “The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach”. Hernia. 2012;16:493–494. doi: 10.1007/s10029-012-0920-7.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する