You have full access to this open access article. 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, , to January 31, , 11, 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 Unadjusted analysis did not find any significant difference in the recurrence rate 0. 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. 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. The longstanding standard practice for TAPP was to use mesh fixation with tackers to prevent recurrence [ 1 ]. But atraumatic mesh fixation fibrin sealants are being increasingly employed to prevent chronic pain in the wake of traumatic fixation methods [ 2 ].
Numerous studies have attested to the excellent results in terms of the recurrence rate achieved with fibrin sealants for atraumatic mesh fixation [ 3 — 6 ]. Comparative studies then explored, in particular for the total extraperitoneal patchplasty TEP , whether mesh fixation could be completely dispensed with [ 7 , 8 ]. In an update of the Guidelines of the International Endohernia Society, ten new studies with evidence level 1 have been included. For TEP, with evidence level 1 A, these stated that fixation and non-fixation of the mesh in TEP were associated with an equal risk of recurrence [ 10 ].
