A comparative study of skin staples versus sutures for fixing mesh in tension-free mesh hernioplasty

Background: In open anterior inguinal mesh hernioplasty, the commonly used method for mesh fixation is by polypropylene sutures which involves extensive mesh fixation and placement of sutures into periosteum of pubic symphysis, thereby increasing the operative time with attendant risk of infection of the prosthetic material. An alternative to sutures is the use of staples which are easy to use and quick to apply. We explored the use of staples in securing the mesh in inguinal hernioplasty. Methodology: A prospective comparative study of 400 patients who underwent inguinal mesh hernioplasty with 200 patients selected randomly each in polypropylene suture (PPSG) and staple group (SG) was performed. Postoperatively patients were made ambulatory on the same day of surgery and discharged from hospital on 1st or 2nd day in both the groups. Follow-up was carried out in 1 week, 2 months, 6 months, 1 year, 2 years, and 3 years and the patients were assessed for wound infection, hematomas, local pain, return to work, recurrence if any, and other miscellaneous complications if any. Results: The mean age of patients in our study in polypropylene suture group and staple group was 46.75 years and 46 years, respectively. 80% (160 patients) in polypropylene suture group and 75% (150 patients) in stapler group had indirect hernia. The mean operative time in PPSG and SG group was 59.25 minutes and 45 minutes, respectively (p value0.05). Overall the complication rate was the same in the two groups with no statistically significant differences observed (P value >0.05). There was 0% recurrence rate in 6 months and 1 year of follow-up in both groups. However, in 3-year follow-up 20 patients (10%) in PPSG and 2 patients (1%) in SG had recurrence (P value=0.0001). Conclusion: The technique of mesh fixation with skin staples is as effective as conventional fixation with polypropylene sutures, with an important added advantage of a significant reduction in the operative time and an early return to work. At the same time this technique does not have any additional complications compared to traditional Lichtenstein method. Good tissue penetrance and effective mesh anchorage are achieved when staples are utilized to secure the mesh.