Fixation versus non fixation of mesh in laparoscopic totally extraperitoneal inguinal hernia repair (TEP)

Background: Persistent groin pain is reported by a significant number of patients following laparoscopic totally extraperitoneal hernia repair (TEP). Mesh fixation has been implicated as a possible cause, but is widely considered essential for mesh stabilization and early recurrence prevention. This study questioned whether elimination of fixation of the mesh during TEP inguinal hernia repair leads to decreased postoperative pain or complications, or both, without an increased rate of recurrence. Methods: A randomized prospective study was carried out on 60 adult male patients who underwent laparoscopic TEP inguinal hernia repair with group A (30) or without group B (30) fixation of the mesh. Results: Patients in whom the mesh was not fixed had less postoperative pain (P value <0.001), shorter hospital length of stay (24.2 versus 28.8 and P value <0.034)and used less postoperative narcotic analgesia. No significant differences occurred in the rate of postoperative complications, time to return to normal activity or the difficulty of the operation between the two groups. No hernia recurrences were observed in either group (follow-up range, 1 to 12 months). Conclusion: Non fixation of mesh during laparoscopic TEP inguinal hernia repair significantly reduces the level of postoperative pain, hospital length of stay and the economic cost. On other hand,  non  fixation  of  mesh  does  not  lead  to  an  increased  rate  of  recurrence.