A randomized controlled trial of a plastic-sheath technique to facilitate self-gripping mesh placement in laparoscopic inguinal hernia repair

BACKGROUND: Self-gripping mesh reduces recurrence and postoperative pain but is difficult to deploy due to its adhesive properties. METHODS: We developed a plastic-sheath covering technique to facilitate mesh placement. In Phase I, prototypes were evaluated for placement time and surgeon satisfaction. In Phase II, a randomized controlled trial (NCT04394338) compared the optimized sheath with conventional placement in laparoscopic inguinal hernia repair. RESULTS: Prototype 4 achieved the shortest placement time in Phase I. In Phase II (n = 26), the plastic-sheath method significantly reduced mesh placement time (4.56 ± 1.80 vs. 7.40 ± 1.52 min; P = 0.005) and improved surgeon satisfaction (8.00 vs. 6.31; P = 0.003). Postoperative pain, hospital stay, and complication rates were comparable between groups. CONCLUSIONS: The plastic-sheath method simplifies self-gripping mesh deployment, reduces operative time, and improves surgeon satisfaction without increasing complications.