Non-Fixation Versus Fixation of Mesh in Totally Extraperitoneal Repair of Inguinal Hernia

Abstract

Background : To compare non-fixation versus fixation of mesh in totally extraperitoneal repair of inguinal hernia. Subjects and Methods: One hundred twenty adult patients age ranged 18-56 years of aged with inguinal hernia were selected among those visiting the general surgery department. Patients were divided randomly into 2 groups and each group had 60 subjects. Group I was non-fixation and group II was fixation group. Parameters such as the operative times, immediate post-op pain, incidence of urinary retention, duration of hospital stay, days taken to return to activity, recurrence rates and chronic groin pain was recorded. Post- operatively, injection paracetamol 1 g 8 hourly was given to all patients on the day of surgery for analgesia. Oral fluids were allowed 6 hours post-operative and progressed to normal diet the next day. Visual analog scale was used to assess pain in the post-op period. Results: ASA grade I was seen among 42 in group I and 38 in group II and II in 18 in group I and 22 in group II. Duration of symptoms was primary symptoms seen among 56 and 52 and recurrent hernia in 4 and 8 in group I and II respectively. Side was unilateral seen in 37 and 40 in group I and II and bilateral in 23 and 20 in group I and II respectively. Operative time (mins) was 42.6 and 35.2, conversion was seen among 3 and 1, injury to viscera in 1 and 2, injury to vas deferens in 1 and 1, injury to testicular vessels in 2 and 1, injury to major vessels in 3 and 4, injury to inferior epigastric vessels was seen in 1 and extensive surgical emphysema in 1 and 1 in group I and group II respectively. A significant difference was observed (P< 0.05) (Table II, Graph II). Conclusion: Decreased operative times, lesser post-operative pain, and decreased costs are advantages of non- fixation inguinal repair.