Bell R C W, Price J G
Department of Surgery, Swedish Medical Center, 499 East Hampden Suite 450, Englewood, CO 80110, USA.
Surg Endosc. 2003 Nov;17(11):1784-8. doi: 10.1007/s00464-002-8763-4. Epub 2003 Sep 10.
Laparoscopic inguinal hernia repair frequently is performed with mechanical fixation of a flat polypropylene mesh. Mechanical fixation is associated with pain syndromes, and mesh migration may occur without fixation of flat prostheses. An anatomically contoured mesh (3D Max; Davol, Cranston, RI, USA) using no or minimal fixation would avoid these problems.
A retrospective case study reviewed 212 transabdominal preperitoneal herniaplasties with 11 x 16-cm 3D Max mesh in 146 patients. Fixation with three helical tacks at the most was used early or with very large defects.
Fixation was used in 19% of the cases, but only for 1 of the last 98 patients. As reported, 94% of the patients returned to normal activities by 3 weeks, 97% returned to unrestricted sports by 6 weeks, and 92% complete recovery from surgery by 9 weeks. Fixation or bilateral repair did not alter recovery. Four patients had minor pain or numbness. Symptomatic recurrence was 0%. One asymptomatic indirect recurrence was noted on examination, during a mean follow-up period of 23 months, yielding a 0.55% hernia rate and a 0.42% patient-year recurrence risk.
An anatomically contoured mesh for transabdominal preperitoneal hernia repair often requires no fixation, with minimal risk of neuropathy and less than a 0.5% patient-year recurrence rate. Recovery is excellent even with bilateral repair or some fixation.
