A new approach to mesh fixation in laparoscopic transabdominal technique, "suture passer", superior or not?

Abstract

Laparoscopic inguinal hernia surgery is a common procedure and pain is a common postoperative complication. Guidelines for mesh fixation vary, with no clear rule. Mesh fixation may not be necessary in total extraperitoneal approach (TEP), but more research is needed for transabdominal preperitoneal approach (TAPP). This study was conducted comparing mesh fixation methods using a suture passer and tacker, aiming to reduce pain and operation time. We used the FUÇA method for mesh fixation in TAPP. The patients were divided into two groups: Group I underwent classical tacker method while Group II used the FUÇA method. There were 52 patients in Group I and 51 patients in Group II. Polypropylene mesh was used in both groups. The surgeries were performed by four experienced surgeons. We analyzed retrospective data including age, gender, BMI, surgical approach, procedure duration, defect size, recurrence status, postoperative pain, hernia type, and complications. Pain was assessed using VAS score and McGill pain index. Recurrence was evaluated by a different surgeon. A total of 103 patients were included: 52 in Group I and 51 in Group II. Both groups had a similar median age (47 years in Group I, 45 years in Group II) and predominantly male participants (92.3% in Group I, 92.2% in Group II). Most patients had indirect inguinal hernia (77.7%) while the rest had direct inguinal hernia (22.3%). There were no significant differences in BMI or hernia type between the groups. The defect size measured by ultrasound was similar in both groups. Group I had higher VAS pain scores on postoperative day 1, at month 1, and at month 3 compared to Group II, but the difference vanished at the 12-month mark. The McGill Pain Index showed similar results. Recurrence was observed in one patient in each group. Complications occurred in 11 patients during the follow-up period, with similar rates between the groups. The mean surgical procedure time of Group 2 was significantly shorter than that of Group 1 (49.36 m vs 43.43 m, p = 0.009). FUÇA method is a technique that can be used safely in the TAPP procedure as it reduces postoperative pain and shortens the operation time.