Adhesion formation in laparoscopic inguinal hernia repair

Background: In laparoscopic inguinal hernia repair controversy exists concerning the most appropriate repair method and implant material to use if intraabdominal adhesions are to be minimized. Methods. In 108 pigs, we implanted three different types of mesh by both the TAPP (transabdominal preperitoneal) and Onlay (prosthesis placed directly upon the peritoneum) methods. Specimens were harvested in three time periods and adhesion formation was compared. Results. Average adhesions at 3 days were TAPP 18% and Onlay 49% (p < 0.001). At 3 weeks average adhesions were TAPP 8% and Onlay 23% (p < 0.04). Three-month figures were TAPP 1% and Onlay 13% (p < 0.001). In contrast, there were no differences in adhesion formation due to material type in any of the three time periods (all p > 0.17). Conclusions: A peritoneal covering over a laparoscopic inguinal implant significantly reduced adhesions. Prosthetic material type did not affect adhesion formation in this study.