What are the mesh fixation options in laparoscopic inguinal hernia repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Whether to fix the mesh in place and which type of fixation device to use are matters of individual surgeon preference. The many options for mesh fixation currently available give the surgeon a range of choices.

In TEP repair, titanium spiral tacks are commonly used to affix the mesh to the Cooper ligament superomedially and superolaterally. Use of more than five tacks has been shown to correlate with higher rates of chronic postoperative pain. [79] Absorbable tacks may be a useful alternative; they are made of a specialized polymer that disintegrates after 4-10 weeks, allowing ample time for the collagen to grow into the interstices of the mesh to anchor it in place.

In TAPP repair, titanium tacks also have traditionally been used to fix the mesh and can also be used to close the peritoneal flap. However, a 2011 report showed that acute pain was increased when more than 10 tacks were placed. [80] A number of surgeons have now switched to using absorbable tacks to fix the mesh and close the peritoneum. Sutures or hernia stapling devices can also be employed.

Some authors have advocated the use of fibrin glue to fixate the mesh. [81, 82, 65] A specialized laparoscopic device can be deployed to direct the application of the fibrin glue. More widely used in Europe, glue fixation appears to be a promising means of decreasing chronic pain. [83]

Still other authors use no fixation at all but instead rely on peritoneal pressure to maintain the mesh in proper position. [84, 85, 62] Short-term study results have been generally favorable, though most surgeons still prefer to employ some method of fixation. An alternative to no fixation might be the use of self-fixating mesh. This product is new to the market, and its efficacy remains to be determined.


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