Early postoperative pain and quality of life with different modalities of mesh fixation in laparoscopic trans-abdominal pre-peritoneal repair of inguinal hernia: a randomized controlled trial

BACKGROUND: Compared with open inguinal hernia repair, laparoscopic approaches, including Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP), improve recovery and reduce pain. However, optimal mesh fixation remains unclear due to limited high-quality comparative evidence. We aimed to evaluate early postoperative pain and quality of life with different mesh fixation modalities (glue, tacks, and sutures) in laparoscopic TAPP inguinal hernia repair. METHODS: A single-center, prospective, randomized controlled trial was conducted on 75 eligible adult patients with primary inguinal hernia scheduled for elective TAPP repair. Patients were randomized in a 1:1:1 ratio to glue (n = 25), suture (n = 25), or tack (n = 25) fixation. Primary outcomes were postoperative pain intensity (visual analogue scale, VAS) and hernia-specific quality of life (Carolinas Comfort Scale, CCS) assessed at postoperative day 1 1, 3, and 6 months. Secondary outcomes included operative time, length of hospital stay, time to return to work, complications, recurrence, and procedural cost. RESULTS: Compared with the glue and suture fixation groups, the tack fixation group had substantially higher pain levels on the first day after the operation and at one month (P < 0.001). Over the 3rd and 6th months, VAS scores were low and comparable across all groups, with no significant differences. The glue group had significantly lower mesh sensation and total CCS scores at all time points compared to the suture and tack groups (P < 0.001). CONCLUSIONS: In the early postoperative period following laparoscopic TAPP inguinal hernia repair, mesh fixation with surgical glue results in superior pain control, better quality of life, and faster return to work compared to sutures and tacks, without increasing early complication rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07401082 (Registered February 6, 2026; retrospectively registered after completion of enrollment).