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. 

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. 

Source publication
Article
Full-text available
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....

Context in source publication

Context 1
... of a possible difficulty in defining the clips, especially medially where the meshes intersect each other, we chose to mark only 1 of the meshes (the right side) with clips. The mesh was marked with 3-mm clips at its lateral inferior, medial inferior, and medial superior corners, the same marking technique that was used in the unilateral NF group (Fig- ure 1). A mesh overlap of at least 3 to 4 cm was observed in relation to potential weakness areas. ...

Citations

... As a result, based on our experience, it was assumed that if SURGIMESH ® XD was utilized for typical hernia cases, the mesh might be un xed. Claus et al. investigated mesh movement in bilateral hernia repair and found that TEP with no mesh xation is safe in bilateral inguinal surgery [19]. Despite the small number of patients in the current investigation, no recurrence of bilateral hernias was found. ...
Preprint
Full-text available
Background: In terms of the need for mesh fixation in total extraperitoneal inguinal hernia repair (TEP), overseas data revealed no significant difference in the recurrence rate between patients with and without fixation. Moreover, there is no information available on this treatment outcome from Japan. We aimed to analyze the outcomes of nonfixation TEP with those of fixation at our institute. Methods: In May 2016, the nonfixation TEP technique was launched. The fixation group (165 patients) was compared to the nonfixation group (195 patients). Bilateral, large, and impaction cases were eliminated from the corrective comparison, and the outcomes for the fixation group (80 patients) and the non-fixation group (111 patients) were compared. Results: One patient in the nonfixation group experienced recurrence. It was a hernia case with a large orifice. In the fixation group, seroma was more prevalent. There was no recurrence and no significance in surgical complications in the correction comparison. The nonfixation group had a shorter operation time and stayed in the hospital for a shorter period after surgery. Conclusions: The nonfixation TEP was deemed adequate, at least for typical hernia cases.
... In the trial evaluating the displacement degree of the mesh with fi xation and mesh without fi xation on the basis of radiograms, there was no statistical diff erence between the position change of fi xed mesh to the one without fi xing. In both cases, mesh displacement was minimal and no more than 0.5 cm from its primary position [16]. In conclusion, the TEP hernia repair without mesh fi xation is an eff ective and safe technique. ...
Article
Inguinal hernia repairs are one of the most common procedures performed in general surgical departments. Approximately 20 million hernia repairs are performed annually all over the world. According to the EHS guidelines, the recommended treatment methods of the inguinal hernia are tension-free techniques: the Lichtenstein open hernia repair and the laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) methods. The TEP hernia repair, first performed by Duluq in 1992, is one of the three current leading techniques in the inguinal hernia repair. The most important advantage of this technique is minimal invasive access without the need to open the peritoneum, which carries a lower risk of abdominal organs injury. Additionally, the TEP method facilitates shorter recovery time, less postoperative pain and an earlier discharge form hospital. The aim of the article is to present the TEP method by comparing it with the other inguinal hernia repair techniques, on the basis of the available literature.
Article
Full-text available
One of the most serious complications after inguinal hernia repair is still the occurrence of chronic pain. The literature describes rates of severe chronic pain of 3%-6%. Laparo-endoscopic inguinal hernia repair is favored to prevent postoperative pain through a minimally invasive approach and sparing of the layers of tissue covering nerves and vessels in terms of reduced risk of damage to these structures. However, the method of fixation of the mesh is still controversial discussed. The use of these penetrating devices such as staples and staplers has been shown to often be complicated by injury to nerves and vessels and occurrence of postoperative pain. The shift to completely atraumatic fixation using adhesives (fibrin glue, cyanoacrylate) began in the early part of this century. Several studies confirmed less postoperative pain after mesh fixation by glue compared to stapler or tacker. Historically, the TEP technique has always been performed without any fixation. Several studies comparing fixation versus non-fixation have been performed in TEP repair and found results with no increase in recurrence rate. Notwithstanding that very few studies comparing fixation versus no fixation with exclusion of large medial inguinal hernias have been published on this topic in TAPP repair, identical results to those with TEP repair were obtained. On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair except for large medial and combined inguinal hernias. If mesh fixation is required, atraumatic techniques should be used.
Article
Full-text available
Purpose The development of chronic pain is one of the major post-surgery problems after inguinal hernia repair. Although the possibility of chronic pain formation decreases with laparoscopic methods, pain may develop due to the staples used. It is thought that absence of mesh fixation in total extra-peritoneal (TEP) repair does not increase the recurrence rate. This study aims to investigate the absence of mesh fixation in the TEP on the development of postoperative pain, mesh displacement, and recurrence rate. Methods Between December 2019 and December 2020, 100 patients who underwent TEP repair due to unilateral inguinal hernia in the General Surgery Clinic of Hitit University were included in the study. Study was registered at http://Clinicaltrials.gov (NCT05152654). Patients were divided into two groups as repairs in which the mesh was fixed with a tacker and no-fixation (NF) was used. The mesh is marked with radiopaque clips. Patients were compared in terms of postoperative pain, mobilization time, hospital stay, return to work, chronic pain, early–late mesh displacement, and recurrence. Results While there was no significant difference between the groups in terms of mesh displacement and recurrence, it was observed that the NF group developed significantly less pain in the early and late postoperative period compared to the other group. The time-dependent reduction rate of postoperative pain was higher in NF group than in other group. In addition, operation time was shorter in the NF group. Conclusion While the absence of mesh fixation in TEP hernia repair does not increase the recurrence rate, it can be used safely, because it causes less acute and chronic pain. Trail registration Clinicaltrials number: NCT05152654.
Article
Full-text available
Background: Inguinal hernia repair is among the most frequent elective or emergency operations performed in general surgical practice. Lichtenstein hernia repair is considered the gold standard for managing such cases. Postoperative complications especially post-surgical chronic groin pain stands still as a very disabling complication. In this study, we investigated the chronic postoperative pain on 2 different types of meshes. Materials and Methods: This is a retrospective study evaluating the results of open herniorrha-phy with self gripping mesh or regular prolene mesh. Patients included the study that was male and aged 18-65 years, which presented with unilateral inguinal hernia and were favorable with Lichtenstein tension-free herniorrhaphy using mesh. Results: The median duration of the operation was 44.6 m ± 6.1 on Group-1 and the median duration of the operation was 24.6 m ± 5.4 on Group-2, as significantly shorter than Group-1 (p< 0.001). The median hospital stay of the patients was 1 day and no statistically significant difference has detected between groups. At follow-up on the third month, the rate of the patients with complaints of mild chronic groin pain in Group-1 was % 11.1 vs none in Group-2(p˂0.05). No recurrence has been detected in both groups after 8.4 months of follow-up. Conclusions: Our experience of lightwight self-gripping mesh demonstrates that the material is both safe and effective in matters of postoperative complications and recurrence and is very promising in prohibiting chronic groin pain.
Background and objectives: There is a dearth of studies on laparoscopic treatment of female groin hernia. Our study assessed the outcome of groin hernia repair in females employing the totally extraperitoneal laparoscopic (TEP) access. Methods: Data of all females who were subjected to laparoscopic groin herniorrhaphy, from August 1998 to February 2020 were retrospectively obtained. Groin hernia repair was routinely started with TEP access. Results: A total of 2,399 patients who underwent laparoscopic groin herniorrhaphy, 254 (10.6%), were females. Most females (n = 191; 75.2%) had single hernia and the remaining (n = 63; 24.8%) had bilateral hernias, making a total of 317 hernias operated. Indirect inguinal hernia was the most common hernia type (72.5%), followed by femoral hernia (17.4%) and direct hernia (10.1%). Prior lower abdominal operations were recorded in 97 (38.2%) patients. Conversion to a laparoscopic transabdominal preperitoneal procedure was performed due to technical difficulties to dissect the preperitoneal space in 17 patients (6.7%) and to open procedure in only one patient (0.4%) with incarcerated femoral hernia in whom an incidental perforation of the small bowel occurred. Intra- and postoperative complications occurred in 12 (4.7%) and 15 (5.9%) patients, respectively. There was no mortality. Most patients (n = 221; 87%) were discharged on the same day of the operation. Hernia recurrence was diagnosed in 6 patients (2.4%). Conclusion: It is concluded that females with groin hernia may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.
Article
BACKGROUND: The ratio change of type I and type III collagen in the peritoneal tissue can be associated with defects in collagen synthesis caused by the extracellular matrix’s degradation. Matrix metalloproteinase-2 (MMP-2) is an enzyme that contributes primarily to the degradation of this extra cell. AIM: This study aimed to analyze the differences in expression of COL1A1, COL3A1, and MMP-2 mRNA and the relationship between these expressions in adult inguinal hernias and the expression ratio between the COL1A1/COL3A1 genes. METHODS: This study was an observational study with a cross-sectional comparative study design, where the sample was adult inguinal hernia patients who were taken from the aponeurosis tissue m. external obliquus performed at the time of surgery, while control was a non-herniated patient. The sample RNA was isolated, followed by cDNA synthesis, and examined by real-time polymerase chain reaction. RESULTS: The mean values of expression for COL1A1, COL3A1, and MMP-2 in the case group were 40.02 ± 181.38 copy number, 33.70 ± 143.62 copy number, and 31.78 ± 84.47 copy number. Meanwhile, the expression values for COL1A1, COL3A1, and MMP-2 in the control group were 40.247 ± 162.837 copy number, 13.35 ± 37.43 copy number, and 20.58 ± 48.95 copy number. CONCLUSIONS: Our study showed a difference in COL3A1 expression between the hernia and non-hernia groups, and no difference was found in the expression of COL1A1 and MMP2 between the hernia and non-hernia groups.
Article
Full-text available
Introduction: The use of implants in inguinal hernia repair has reduced its recurrence rate. However, postoperative groin pain still remains an unresolved problem. There are suggestions that in totally extraperitoneal inguinal hernia repair (TEP-IHR) two of the likely factors responsible for pain are use of fixation and the type of fixation used. Aim: To evaluate the impact of mesh fixation on the incidence of postoperative pain, restriction of physical activities, hernia recurrence risk, return to normal activities and demand for analgesics in patients after unilateral TEP-IHR. Material and methods: Unilateral TEP-IHR was performed in 139 male patients randomized to three groups: self-gripping mesh (SG), lightweight mesh (L) and lightweight mesh with fixation (LF). Full study-inclusion criteria were met by 110 patients; 43, 18 and 49 in groups SG, L and LF respectively. Follow-up occurred on the 1st, 2nd, and 7th day and 3, 6, 12 months postoperatively. The numeric rating scale (NRS) was used to assess pain and the EuraHS-QoL (European Registry for Abdominal Wall Hernias Quality of Life Score) questionnaire to compare quality of life (QoL) prior to surgery and one year later. Results: No statistically significant differences were observed between study groups with regard to the incidence rate and intensity of acute post-operative pain, chronic pain, analgesic demand, return to normal activity, hernia recurrence rate and post-operative QoL. Conclusions: Lack of fixation in TEP-IHR does not increase the risk of hernia recurrence, and its presence does not significantly worsen the treatment results; especially it does not increase the incidence of chronic pain.