Transabdominal Preperitoneal (TAPP) Hernia Repair with and without Mesh Fixation with Tacks

Abstract

Background: Laparoscopic inguinal hernia (IH) repair is now the recommended way of treatment for inguinal hernias. Transabdominal preperitoneal (TAPP) entails access to the peritoneal cavity and implantation of a mesh into the preperitoneal space after the hernia sac has been reduced. Mesh placement is accomplished using either spiral tack fixation or non-fixation. Objective: To compare the mean pain scores using visual analogue scale (VAS) in patients undergoing TAPP hernia repair with and without mesh fixation using spiral tacks. Study Design: Randomized controlled trial. Settings: Department of General Surgery, Allied Hospital, Faisalabad, Pakistan. Duration: June 2019 to November 2019. Methods: Research participants were divided into two groups. All operations were performed under general anesthesia by an experienced laparoscopic surgical team. In Group A patients, mesh was anchored and in Group B patients mesh was not anchored.  After confirming satisfactory placement of mesh, peritoneum was closed using Vicryl 2/0 suture. Patients in both groups were compared for the degree of pain experienced by them using visual analogue score (VAS) 24 hours after surgery then followed up after 1 month. Results: Comparison of mean pain scores using VAS between patients undergoing TAPP hernia repair with and without mesh fixation with tacks at 24 hours was calculated as 3.57±1.04 in Group-A and 2.07±0.74 in Group-B, p-value was 0.0001, while after 1 month of the procedure, it was 2.17±0.70 in Group-A and 0.93±0.87 in Group-B, p-value was 0.0001. Conclusion: It is observed that patients undergoing TAPP hernia repair without mesh fixation had significantly lower post-operative pain when compared to those with mesh fixation using spiral tacks.