Background: Laparoscopic inguinal hernial repair, including the “transabdominal preperitoneal repair" (TAPP),
has become popular in Egypt. Nonetheless, mesh fixation during that procedure has been questioned. Some
surgeons believe that the fixation step is essential to prevent mesh migration and recurrence, whereas others
believe that fixation carries more risk of chronic postoperative pain. Herein, we compared the outcomes of mesh
fixation versus non-fixation in such cases.
Patients and methods: Forty patients scheduled for TAPP were enrolled in our randomized prospective trial.
Two approaches were used: mesh fixation (20 patients) and non-fixation (20 patients). The main outcome was
the operative duration, whereas secondary ones included early and late postoperative adverse events (within a
one-year follow-up).
Results: We noted no notable differences regarding patient and hernia parameters when comparing the two
groups. When mesh fixation was omitted, the operative time significantly decreased (45 vs. 80 minutes in the
other group – p = 0.002). No patients developed wound infection, testicular atrophy, or postoperative recurrence
during the one-year follow-up. The occurrence of seroma and hematoma was similar in statistical terms across
both groups. Nonetheless, mesh fixation yielded a significant rise (p = 0.035) in chronic postoperative inguinodynia
(20%) while not encountered in the other group (0%). That made patient satisfaction better in the non-fixation
group (p = 0.040).
Conclusion: Omitting mesh fixation during the TAPP procedure does not add significant risks to the perioperative
and one-year outcomes. Contrarily, it yielded significant benefits, including shorter operative time, less incidence
of inguinodynia, and better satisfaction.