Background
There are different options for mesh fixation and peritoneal flap (PF) closure in the laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair. There is no best operative technique with wide variations in these options. In our study, we aimed to compare the outcomes of totally sutured technique (for mesh fixation and PF closure) and the tacks technique in TAPP laparoscopic inguinal hernia repair regarding operative time, cost benefits, and postoperative complications.
Patients and methods
This is a prospective randomized controlled study performed at Ain Shams University Hospitals between February 2019 and February 2022. It included 80 patients diagnosed as having an inguinal hernia and underwent laparoscopic TAPP repair. The patients were divided equally into two groups according to the method of mesh fixation and PF closure: group A: totally tacks and group B: totally sutured.
Results
We had a highly significant difference between both groups regarding operative time (87.5 min in group A vs. 117 min in group B). We had a nonsignificant difference between both groups regarding operative complications. Both groups did not show a significant difference in the hospital stay (25.6 h in group A vs. 23.6 h in group B). There was a nonsignificant difference between both groups in inguinoscrotal edema/hematoma, surgical-site infection, and recurrence. There was a nonsignificant difference between both groups in early postoperative pain, while the late pain was significantly less in the suture group. Regarding the cost analysis, group B was cost-effective compared with group A.
Conclusion
Although the totally sutured technique (for mesh fixation and PF closure in laparoscopic TAPP inguinal hernia repair) was a significantly longer in operative time, it provided a significant improvement in late postoperative pain with a significantly lower cost than the tack technique with no significant difference in recurrence at short-term follow-up.