Total Extraperitoneal Repair (TEP) for Inguinal Hernia without Mesh Fixation

Abstract

Objective: To determine the outcome of TEP without mesh fixation in terms of post-operative pain, seroma formation & mesh displacement with recurrence. Study Design: Prospective randomized study. Settings: Surgical unit 4 DHQ Hospital, Faisalabad Pakistan. Duration: November 2015 to May 2017. Methodology: A total of 100 patients with age ranging from 19 to 65 years and fulfilling the criteria were included in the study. All operations were performed by the same surgeon with the patient under general anesthesia. Follow-up of patients for post-operative pain by a visual analog score (VAS) 1 to 10, sensation of foreign body and recurrence of hernia was done at 1 month, 3 months, 6 months and 1 year after surgery. Results: The age of the patients ranged from 19 to 65 years with mean age 42 years. All the patients were male (100%). 52 (52%) patients had right sided hernia, 35 (35%) had left sided while 13 (13%) of them had bilateral hernias. Among the left sided 1 (2.85%) was recurrent. 73 (73%) patients had indirect hernia, 24 (24%) had direct hernia while 3 (3%) patients had pantaloons hernia. The VAS for pain was between 2 and 5 on 1st postoperative day. On 1st visit, 1 (1%) patient had purulent port site discharge, he was readmitted and was managed accordingly. There were no complaints by the patients in terms of chronic pain, mesh displacement and recurrence at 2nd, 3rd and 4th follow up visits except 1 (1%) patient with displacement of mesh forming a meshoma and recurrence. Conclusion: Fixation of the mesh to the abdominal wall has been controversial and although many surgeons consider it necessary to fix the mesh, but it may be considered to be associated with various postoperative complications for no additional benefit in lowering recurrence rates. In non-recurrent inguinal hernia, non-fixation of the mesh is safe and reliable as proved by the study. In our study, we did not take into account the BMI of patient, the size of hernia, the type and the size of mesh. Therefore, further studies with larger sample sizes taking into account the other variables are necessary for subgroup analyses.