Optimization of inguinal hernia management using a non-fixation laparoscopic hernioplasty technique
DOI:
https://doi.org/10.15574/PS.2026.1(90).5358Keywords:
inguinal hernia, TAPP hernioplasty, non-fixation mesh, postoperative pain, chronic pain, recurrence, quality of lifeAbstract
Inguinal hernias are the most common anterior abdominal wall hernias, and postoperative pain remains a major factor affecting recovery and quality of life. Mechanical mesh fixation contributes to pain-related morbidity. Anatomical three-dimensional (3D) meshes used during laparoscopic transabdominal preperitoneal hernioplasty (TAPP) without additional fixation may reduce tissue trauma without increasing recurrence rates.
Aim - to evaluate the clinical effectiveness and safety of non-fixation TAPP hernioplasty compared with the fixation technique.
Materials and methods. A single-center comparative study included 156 patients: the control group (CG, n=87) underwent TAPP with mesh fixation (tackers or sutures); the study group (SG, n=69) underwent TAPP with non-fixation implantation of an anatomical 3D mesh. Pain was assessed using a visual analogue scale (VAS). Recurrence, chronic pain lasting >3 months, operative time, length of hospital stay, early complications, and quality of life according to the Short Form-36 questionnaire (SF-36; 0-100 points) were analyzed.
Results. In the SG, operative time was reduced by 9.8% (61.5±9.3 vs 68.2±11.4 min; p<0.001), and hospital stay was shortened by 30.8% (1.8±0.5 vs 2.6±0.9 days; p<0.001). VAS pain scores were lower by 42.9% on day 1 and by 48.4% on day 3 (p<0.001). Opioid requirements decreased by 64.8% (10.1% vs 28.7%; p=0.006). No recurrences were detected in the SG (0% vs 2.3%), and the incidence of chronic pain decreased by 87.8% (1.4% vs 11.5%; p=0.02). SF-36 scores for physical functioning, role physical functioning, bodily pain, and social functioning were higher in the SG (p≤0.01).
Conclusions. Non-fixation TAPP using anatomical 3D meshes is effective and safe: it provides 100% recurrence-free outcomes, reduces chronic pain by 87.8%, opioid use by 64.8%, and hospital stay by 30.8%.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the aforementioned institution. Informed consent was obtained from the patients for the study.
The authors declare no conflict of interest.
References
Alaverdyan H, Maeng J, Park PK, Reddy KN, Gaume MP, Yaeger L et al. (2024, Sep). Perioperative Risk Factors for Persistent Postsurgical Pain After Inguinal Hernia Repair: Systematic Review and Meta-Analysis. J Pain. 25(9): 104532. Epub 2024 Apr 8. https://doi.org/10.1016/j.jpain.2024.104532; PMid:38599265
Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, et al. (2015). Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia: International Endohernia Society. Surgical Endoscopy. 29(2): 289-321. https://doi.org/10.1007/s00464-014-3917-8; PMid:25398194 PMCid:PMC4293469
Bittner R, Montgomery MA, Arregui ME, Misra MC. (2021). Laparo-endoscopic hernia repair - TAPP & TEP techniques. Annals of Surgery. 273(3): 456-462. https://doi.org/10.1097/SLA.0000000000004220; PMid:33055591
Calomino N, Poto GE, Carbone L, Micheletti G, Gjoka M, Giovine G et al. (2024, Dec). Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study. Am J Surg. 238: 115950. Epub 2024 Sep 7. https://doi.org/10.1016/j.amjsurg.2024.115950; PMid:39265512
Chen Y, Li X, Zhao W. (2024). Non-fixation versus fixation in laparoscopic TAPP inguinal hernia repair: A randomized controlled trial. BMC Surgery. 24(1): 112. https://doi.org/10.1186/s12893-024-02628-4; PMid:39420306 PMCid:PMC11484319
Collaborators GBD. (2021). Global burden of inguinal, femoral, and abdominal hernia in older adults from 1990 to 2019: A systematic analysis. The Lancet Public Health, 6(12): e836-e845. https://doi.org/10.1016/S2468-2667(21)00204-3.
Deveci CD, Öberg S, Rosenberg J. (2023, Apr 13). Definition of Mesh Weight and Pore Size in Groin Hernia Repair: A Systematic Scoping Review of Randomised Controlled Trials. J Abdom Wall Surg. 2: 11179. https://doi.org/10.3389/jaws.2023.11179; PMid:38312405 PMCid:PMC10831688
Dong H, Li L, Feng HH, Wang DC. (2023, Oct 30). Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials. Surg Open Sci. 16: 138-147. https://doi.org/10.1016/j.sopen.2023.10.006; PMid:37964861 PMCid:PMC10641249
Eklund A, Sandblom G, Rudberg C. (2021). Short- and long-term outcomes of non-fixation in TEP and TAPP hernia repair. Surgical Endoscopy. 35(9): 5123-5131. https://doi.org/10.1007/s00464-020-07872-7.
Gram-Hanssen A, Öberg S, Rosenberg J. (2023, Jan 19). A Critical Appraisal of the Chronic Pain Rate After Inguinal Hernia Repair. J Abdom Wall Surg. 2: 10972. https://doi.org/10.3389/jaws.2023.10972; PMid:38312409 PMCid:PMC10831660
HerniaSurge Group. (2018). International guidelines for groin hernia management. Hernia. 22(1): 1-165. https://doi.org/10.1007/s10029-017-1668-x; PMid:29330835 PMCid:PMC5809582
Huguenin-Dezot M, Peisl S, Georgiou E et al. (2024). Glued suture-less peritoneum closure in laparoscopic inguinal hernia repair reduces acute postoperative pain. Sci Rep. 14: 11786. https://doi.org/10.1038/s41598-024-62364-w; PMid:38782992 PMCid:PMC11116422
Iossa A, Traumueller Tamagnini G, De Angelis F, Micalizzi A et al. (2024, Jul 15). TEP or TAPP: who, when, and how? Front Surg. 11: 1352196. https://doi.org/10.3389/fsurg.2024.1352196; PMid:39077677 PMCid:PMC11284065
Jaiswal RK, Pandey NK, Tolat A, Kalwaniya DS, Gupta AK, Naga Rohith V et al. (2023, Jul 20). A Prospective Comparative Study of Laparoscopic Totally Extraperitoneal (TEP) and Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Hernial Repair. Cureus. 15(7): e42209. PMID: 37601986; PMCID: PMC10439812. https://doi.org/10.7759/cureus.42209
Jiang T, Zhang C, Wang XL, Yue DC, Yuan XP, Wang DC. (2024, Oct 17). Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis. BMC Surg. 24(1): 317. https://doi.org/10.1186/s12893-024-02628-4; PMid:39420306 PMCid:PMC11484319
Köckerling F. (2022). TAPP versus TEP: Update 2022. Hernia. 26(1): 23-32. https://doi.org/10.1007/s10029-021-02485-4.
Nahid AK, Rahman S, Veerapatherar K, Fernandes R. (2021, Mar 22). Outcomes on mesh fixation vs non-fixation in laparoscopic totally extra peritoneal inguinal hernia repair: a comparative study. Turk J Surg. 37(1): 1-5. https://doi.org/10.47717/turkjsurg.2021.4962; PMid:34585087 PMCid:PMC8448564
Raja S, Raja A, Ansari Z, Eman S, Bajaj S, Ahmed M et al. (2024, Feb 9). Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy. Front Surg. 11: 1321325. https://doi.org/10.3389/fsurg.2024.1321325; PMid:38404293 PMCid:PMC10884233
Riemenschneider KA, Lund H, Pommergaard HC. (2023, Nov). No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 37(11): 8291-8300. Epub 2023 Sep 6. https://doi.org/10.1007/s00464-023-10237-0; PMid:37674053 PMCid:PMC10615908
Simons MP, Aufenacker TJ, Berrevoet F. (2022). European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 26(6): 1283-1299. https://doi.org/10.1007/s10029-021-02420-7.
Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. (2023). Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 7(5): zrad080. https://doi.org/10.1093/bjsopen/zrad080; PMid:37862616 PMCid:PMC10588975
Thölix AM, Kössi J, Grönroos-Korhonen M, Harju J. (2025, Apr). Laparoscopic inguinal hernia repair with self-fixated meshes: a randomized controlled trial. Surg Endosc. 39(4): 2425-2435. Epub 2025 Feb 20. https://doi.org/10.1007/s00464-025-11616-5; PMid:39979619 PMCid:PMC11933136
Zhang C, Li J, Suo H, Bai J. (2024, Dec 6). Non-fixation versus fixation of mesh in laparoscopic transabdominal preperitoneal repair of inguinal hernia: A systematic review and meta-analysis of randomized controlled trials. PLoS One. 19(12): e0314334. https://doi.org/10.1371/journal.pone.0314334; PMid:39642172 PMCid:PMC11623461
Zhang Q, Liu J, Wang H. (2023). Long-term outcomes of non-fixation mesh in laparoscopic inguinal hernia repair: A prospective study. International Journal of Surgery. 107: 106993. https://doi.org/10.1016/j.ijsu.2023.106993.
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