Commencing Mesh Fixation with Sutures versus Non-Fixation Technique in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair.

Background: Laparoscopic inguinal hernial repair, including the “transabdominal preperitoneal repair” (TAPP),has become popular in Egypt. Nonetheless, mesh fixation during that procedure has been questioned. Somesurgeons believe that the fixation step is essential to prevent mesh migration and recurrence, whereas othersbelieve that fixation carries more risk of chronic postoperative pain. Herein, we compared the outcomes of meshfixation versus non-fixation in such cases.Patients and methods: Forty patients scheduled for TAPP were enrolled in our randomized prospective trial.Two approaches were used: mesh fixation (20 patients) and non-fixation (20 patients). The main outcome wasthe operative duration, whereas secondary ones included early and late postoperative adverse events (within aone-year follow-up).Results: We noted no notable differences regarding patient and hernia parameters when comparing the twogroups. When mesh fixation was omitted, the operative time significantly decreased (45 vs. 80 minutes in theother group – p = 0.002). No patients developed wound infection, testicular atrophy, or postoperative recurrenceduring the one-year follow-up. The occurrence of seroma and hematoma was similar in statistical terms acrossboth groups. Nonetheless, mesh fixation yielded a significant rise (p = 0.035) in chronic postoperative inguinodynia(20%) while not encountered in the other group (0%). That made patient satisfaction better in the non-fixationgroup (p = 0.040).Conclusion: Omitting mesh fixation during the TAPP procedure does not add significant risks to the perioperativeand one-year outcomes. Contrarily, it yielded significant benefits, including shorter operative time, less incidenceof inguinodynia, and better satisfaction.