I. S. Pourladian1, A. W. Lois1, M. J. Frelich1, A. S. Kastenmeier1, J. R. Wallace1, J. C. Gould1, M. I. Goldblatt1 1Medical College Of Wisconsin,General Surgery,Milwaukee, WI, USA
Introduction: Inguinal herniorrhaphy is one of the most common surgical procedures performed annually. Several synthetic meshes are available to reinforce the inguinal region following laparoscopic hernia reduction. Historically, most surgeons secure mesh with tacks; however, self-adhering mesh now allows the elimination of fixating tacks. We sought to compare postoperative outcomes of patients who underwent laparoscopic inguinal herniorrhaphy using self-adhering polyester mesh to those who had non-adhering, synthetic mesh implanted using absorbable tacks.
Methods: This study is a retrospective review of patients who underwent primary laparoscopic inguinal herniorrhaphy at the Medical College of Wisconsin between October 2012 and July 2014. Procedures were performed by four surgeons. Clinical information and perioperative outcomes were collected up to one year following surgery when available. The Surgical Pain Scale (SPS) was used to evaluate pain preoperatively, at two weeks, six weeks, six months, and one year after surgery.
Results: One hundred and four patients (94 male) underwent laparoscopic inguinal herniorrhaphy during the study interval. Forty-two patients received the self-adhering mesh and 62 patients received a mesh adhered with tacks. Patient demographics and comorbidities did not differ significantly between the two groups. The mean patient age was 51.5 (±14.3) years with a mean BMI of 26.5 (±4.0). Complications, which included seroma, hematoma, urinary retention, emesis, and constipation, did not differ between groups perioperatively or post-discharge (p=0.7 and p=0.06, respectively). No hernias recurred in either group during the study interval.
Conclusion: Postoperative complications did not occur more frequently in patients undergoing laparoscopic inguinal herniorrhaphy receiving non-adhering mesh implanted using absorbable tacks versus self-adhering mesh. SPS responses differed significantly at six weeks suggesting that patients receiving self-adhering mesh may experience less postoperative pain in the short term compared to tacked, non-adhering mesh, but this advantage goes away as the tacks dissolve. We will continue to follow patients to evaluate for risk of recurrence and other postoperative complications.
