gms | German Medical Science

Introduction: Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence this study now seeks to explore this subject on the basis of prospective data from the Herniamed Hernia Registry.

Patients and Method: In the period 1 September 2009 to 31 January 2014, 11,228 male patients were operated on with the TAPP technique for a primary unilateral inguinal hernia and were followed up for one year. Mesh fixation was used for 7,422 (66.1%) of these patients, and no mesh fixation for 3,806 patients (33.9%).

Results: Unadjusted analysis did not find any significant difference in the recurrence rate (0.88% with fixation versus 1.1% without fixation; p=0.259). Multivariable analysis of all potential influence factors (age, ASA, BMI, risk factors, defect size, mesh fixation) did not identify any factor that impacted recurrence on one-year follow up. Only for medial and combined defect localization versus lateral localization was a highly significant effect identified (p<0.001). By fixing the mesh in case of larger medial and combined hernia recurrence rates can be decreased significantly (p = 0.046).

Conclusion: In TAPP repair of an inguinal hernia fixation of the mesh is not necessary in a significant number of patients. Patients with a medial and combined hernia are at higher risk for recurrence.

In those cases by a medial fixation of the mesh the recurrency rate can be decreased significantly.