Laparoscopic Total Extraperitoneal Hernia Repair: Mesh Fixation Is Unnecessary

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Abstract
Background: Inguinal hernia repair contributes significantly to the general surgeon's workload. Since the evolution of laparoscopic inguinal hernia repair, the total extraperitoneal (TEP) repair is the technique most commonly employed by laparoscopic surgeons. This technique involves the placement of a polypropylene mesh in the preperitoneal space. The issue of fixation of this mesh remains unresolved. Surgeons have previously fixed this mesh in place using laparoscopic stapling devices, suturing techniques, or, more recently, polycyanoacrylate adhesives. However, stapling the mesh not only increases the time and expense of the procedure but can cause specific complications such as nerve entrapment syndromes and osteitis pubis. Patients and Methods: We report a series of 89 total extraperitoneal laparoscopic repairs in 80 consecutive patients using no means of mechanical or adhesive mesh fixation, irrespective of the size of the hernial defect. Results: Follow-up revealed no increase in morbidity or hernia recurrence. Conclusion: Our experience suggests that mechanically fixing the mesh in the preperitoneal space is unnecessary. Not fixing the mesh avoids possible complications and is not associated with any increased risk of hernia recurrence.