Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias

Background  This study aimed to examine the recurrence rate and postoperative pain in total extraperitoneal repair (TEP) performed without fixation of the mesh and to compare the rates with those for repairs using fixation of mesh. Methods  A retrospective analysis was conducted over a 3-year period for 929 patients (1,753 hernias) who had undergone TEP. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days until resumption of normal activities, seroma formation, and urinary retention rates were noted. Results  Of the 929 patients (1,753 hernias), the mesh was fixed (Fx) for 33 (61 hernias) and not fixed (NFx) for 896 (1,692 hernias). The follow-up period ranged from 6 to 40 months (mean, 17 months). The two groups did not differ significantly in terms of mean operating time, proportion of patients who had minimal or no pain (score, 1 or 2) 24 h after surgery, or proportion of patients who were totally pain free (score = 1) 1 week postoperatively. The proportions of patients reporting pain at the end of 1 month, the incidence of seroma formation and urinary retention, the hospital stay, and the days until resumption of normal activities were significantly greater in the Fx group than in the NFx group (p < 0.0001). Two patients (0.22%) in the NFx group had recurrence and one patient in the Fx group underwent conversion to open hernia repair. Conclusions  This study found TEP without mesh fixation to be safe and feasible with no increase in recurrence rates. The TEP procedure is associated with significantly less pain at 4 weeks, lower incidence of urinary retention and seroma formation, shorter hospital stay, and early resumption of normal activities.