Document Detail


Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial.
MedLine Citation:
PMID:  17885789     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A new persistent groin pain is reported by a significant number of patients following laparoscopic totally extraperitoneal hernia repair (TEP). Mesh fixation has been implicated as a possible cause, but is widely considered essential for mesh stabilization and early recurrence prevention. This study investigates whether any association exists between mesh fixation by metal tacks and the incidence of new groin pain or early hernia recurrence. METHODS: A prospective multicenter double-blinded randomised trial was conducted between December 2004 and January 2006. Standardized TEP repair was performed with a rectangular 10 x 15cm polypropylene mesh. Hernia were randomized to either mesh fixation by metal tacks or left entirely unfixated. Clinical review by physical examination was performed by a separate blinded surgeon after a minimum of six months, with another review planned after two years. The incidence of new groin pain and recurrence were compared. RESULTS: Five hundred herniae in 360 patients were entered into the study. At the first wave of clinical follow-up (median eight, range 6-13 postoperative months) a new pain was reported by 38 versus 23% (p = 0.003), occurring at least once a week in 22 versus 15% (p = 0.049), or several times per week in 16 versus 8% (p = 0.009) for fixated versus unfixated repairs, respectively. Patients with bilateral repairs were five times more likely to report the unfixated side being more comfortable (p = 0.006). There was one recurrence in the fixated group (1/247) whilst none have yet occurred in the unfixated group. Fixation increased operative costs by approximately 375 AUD. CONCLUSION: Mesh fixation in TEP is associated with increased operative cost and chronic pain but no difference in the risk of hernia recurrence at six months was observed.
Authors:
Craig Taylor; Laurent Layani; Victor Liew; Michael Ghusn; Nic Crampton; Stephen White
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2007-09-21
Journal Detail:
Title:  Surgical endoscopy     Volume:  22     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-04     Completed Date:  2008-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  757-62     Citation Subset:  IM    
Affiliation:
Laparoscopic Surgery, John Flynn Gold Coast Hospital, Gold Coast, QLD, Australia. craigtaylor_007@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Double-Blind Method
Female
Follow-Up Studies
Hernia, Inguinal / diagnosis,  surgery*
Humans
Laparoscopy / adverse effects,  methods*
Male
Middle Aged
Pain Measurement
Pain, Postoperative / physiopathology
Postoperative Complications / physiopathology
Probability
Prospective Studies
Recurrence / prevention & control
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Surgical Mesh*
Wound Healing / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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