Evaluation of mesh fixation versus non-fixation in laparoscopic mesh hernioplasty in inguinal hernias


  • Shubra Kochar Department of General Surgery, Govt. Medical College Patiala, Punjab, India
  • Dipanshu Kakkar Department of General Surgery, PT. B.D Sharma PGIMS Rohtak, Haryana, India
  • Devendra Pal Singh Department of General Surgery, Govt. Medical College Patiala, Punjab, India




Hernia, Laparoscopic hernia repair, TEP, TAPP, LIHR



Background: Laparoscopic inguinal hernia repair (LIHR) is usually done by two methods, which vary in approach to the preperitoneal space; transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). This study aimed at comparing the effect of mesh fixation and non-fixation in terms of operative time, hospital stay, analgesic requirement, complications and cost analysis with respect to fixation device in LIHR.

Methods: This prospective randomized comparative study included 60 patients of inguinal hernias admitted to the Department of Surgery at Rajendra Hospital, G.M.C, Patiala from July 2016 to September 2017 (duration of study was 15 months). Cases were divided into two groups by draw of lots with group A as mesh fixation (n=30) and group B as non-fixation (n=30).

Results: The results were calculated with chi square test (p value). Results were found to be not significant in two groups in the terms of postoperative analgesia, complications i.e. (intraoperative, postoperative and long term) postoperative hospital stay and time to return for work. The cost of procedure was found to be very high in Group A and results were highly significant (p<0.001).

Conclusion: LIHR repair without mesh fixation shows advantages over mesh fixation, which includes significant less cost of surgery, with comparable intraoperative, postoperative and long-term complications (with no increase in hernia recurrence), hospital stay and mean operative time. Hence, our study favours LIHR without mesh fixation a valuable alterative option.


Panton ONM, Panton RJ. Laparoscopic hernia repair.AM J Surg 1994;167:535-537.

Crawford DL, Phillips EH. Laparoscopic repair and groin hernia surgery. Surg Clin N Am 1998;78:6:1047-1088.

Stoppa RE.Petit J, Henry X. Unsutured Dacron Prosthesis in groin hernias. Int J Surg 1975;60:411-412.

Fitzgibbons Jr RJ, Camps J, Cornet DA, Nguyen NX, Litke BS, Annibali R, Salerno GM. Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Annals of surgery. 1995 Jan ;221(1):3-13.

M.S. Sajid, N. Ladwa, L. Kalra, K. Hutson, P. Sains, M.K. Baig . A meta-analysis examining the use of tacker fixation versus no-fixation of mesh in laparoscopic inguinal hernia repair.International Journal of Surgery 10 (2012) 224e231

Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a metaanalysis of randomized controlled trials. World J Surg 2010;34: 3065e74.

Spaw A: Laparoscopic hernia repair: The anatomic basis. J Laparoendosc Surg 1991; 1: 269– 277.

Koch CA, Grinberg GG, Farley DR. Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg. 2006;191:381–385.

Garg P, Rajagopal M, Varghese V, Ismail M. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 2009;23:1241e5.

Gilbert AI. Generations of the plug and patch repair: its development and lessons from history. Chapter 172. In: Baker RJ, Fischer JE, editors, Master of Surgery, vol. 11, 4th edition. Philadelphia: Lippincott William and Wilkins. 2001; 1975-1982.

Felix EL, Michas CA, Gonzalez JR. Laparoscopic hernioplas¬ty Tapp vs Tep. Surg Endosc. 1995;9:984-989.

Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S. Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomized clinical trial. Surg Endosc 2008;22:757e62.






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