Yilmaz Abdullah Hilmi, Ulutas Mehmet Esref
Department of Surgery, Van Training and Research Hospital, University of Health Sciences, Süphan Mahallesi Hava Yolu Kavşağı 1. Kilometre EDREMIT/Van, Van, Türkiye.
Department of Surgery, Gaziantep City Hospital, University of Health Sciences, Gaziantep, Türkiye.
Updates Surg. 2025 May 28. doi: 10.1007/s13304-025-02271-5.
Mesh fixation, one of the controversial issues of laparoscopic surgery, has not been investigated in the enhanced view-totally extraperitoneal (eTEP) technique. This study aimed to compare mesh fixation (FX) and non-fixation (NFX) in difficult cases in the eTEP technique.
A total of 61 consecutive patients diagnosed with inguinal hernias who underwent the eTEP procedure were randomized for the study. The groups were FX and NFX. The primary outcome was mesh displacement; secondary outcomes were recurrence, return to normal life, pain, and postoperative findings.
Mesh displacement, recurrence, mean operative time, length of stay, pneumoperitoneum, and postoperative complications were similar. VAS scores were higher in the FX group (p = 0.017, p < 0.001, p < 0.001, respectively). Return to normal life was more days in the FX group (p = 0.02). The mesh displacement at 6 months was higher than at 1 month in both groups (p < 0.001).
There is no increased risk of mesh displacement and recurrence in difficult cases, such as scrotal and recurrent hernias, without mesh fixation. With the eTEP technique, mesh fixation can be safely avoided for less pain and a faster return to normal life.
Clinicaltrials number: NCT06417359.
补片固定是腹腔镜手术中颇具争议的问题之一，目前尚未在增强视野完全腹膜外（eTEP）技术中进行研究。本研究旨在比较eTEP技术在困难病例中补片固定（FX）与非固定（NFX）的效果。
连续61例诊断为腹股沟疝并接受eTEP手术的患者被随机纳入本研究。分为FX组和NFX组。主要结局是补片移位；次要结局是复发、恢复正常生活情况、疼痛及术后检查结果。
补片移位、复发、平均手术时间、住院时间、气腹及术后并发症情况相似。FX组视觉模拟评分（VAS）更高（分别为p = 0.017、p < 0.001、p < 0.001）。FX组恢复正常生活所需天数更多（p = 0.02）。两组6个月时的补片移位均高于1个月时（p < 0.001）。
在阴囊疝和复发性疝等困难病例中，不进行补片固定不会增加补片移位和复发风险。采用eTEP技术时，可安全避免补片固定，以减轻疼痛并更快恢复正常生活。
临床试验编号：NCT06417359。
