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A cross-sectional study on fixation versus non-fixation for laparoscopic inguinal herniorrhaphy of patients with inguinal hernia in St. Luke’s Medical Center, Quezon City from 2010-2014

Menandro Siozon, Jonathan Joy Adora, Jeffrey Jeronimo Domino, Maria Millicent Carino. MD, Mark Francis A. Melendres. MD

Introduction: There is still no concrete recommendation as to the use of fixation vs non-fixation during total extraperitoneal laparoscopic inguinal hernia repair. The proponents of this study aims to determine the effectiveness and safety, in terms of intra-operative and short-term post-operative complications, operative time, and hospital stay, following mesh fixation versus non-fixation in laparoscopic inguinal hernia repair.

Methodology: This is a cross-sectional study including all patients who underwent laparoscopic inguinal hernia repair, both TEP and TAPP approach, in St. Luke’s Medical Center, Quezon City, Philippines, from 2010 to 2014. Parameters evaluated in this study were operative time, hospital stay, intraoperative and postoperative complications, and early post-operative pain, in patients who underwent laparoscopic hernia repair with fixation compared to non-fixation. Medical records of the patients were reviewed.

Results: The use of fixation has a 12% less chance of prolonged operative time compared to non-fixation technique, and considered statistically significant with p value = 0.02. The use of fixation is associated with 36% less chance of having high VAS post-operative pain, and 6% less chance of prolonged hospital stay compared with non- fixation; however, no significant difference was found with the odds ratio with p value = 0.62 and p value = 0.07, respectively. No complications such as hematoma, seroma, wound infection, trochar hernia, trochar site bleeding, conversion to open procedure, and bowel injury were noted in both groups.

Conclusion: Non-fixation of mesh in laparoscopic inguinal hernia repair is safe and feasible. Application of fixation materials in laparoscopic herniorrhaphy with mesh may not be necessary due to comparable length of hospital stay and early post-operative pain in patients with fixation, and no complications such as hematoma, seroma, wound infection, trochar hernia, trochar site bleeding, conversion to open procedure, and bowel injury were noted. Operative time as a parameter of outcome should be carefully evaluated because of several confounding factors.