COMPARATIVE OUTCOMES OF MINIMAL FIXATION AND NON-FIXATION TECHNIQUES IN LAPAROSCOPIC TAPP HERNIOPLASTY

Abstract

The need for mesh fixation in laparoscopic TAPP hernioplasty remains an open question. Laparoscopic TAPP was performed in a single centre on 80 military servicemen: the main group (n=40) received the mesh with minimal single-point fixation (to the periosteum at the pubic bone–inguinal (Poupart’s) ligament junction) together with extended preoperative preparation; the control group (n=40) received the mesh without fixation and standard preparation. The groups differed in two respects — fixation and preparation — and therefore the study cannot evaluate fixation in isolation. Results: for every complication the trend favoured minimal fixation, but none reached statistical significance on Fisher’s exact test: seroma 5.0% vs 15.0% (p=0.263), scrotal haematoma 0% vs 10.0% (p=0.116), prolonged exudation 2.5% vs 10.0% (p=0.359), recurrence 0% vs 7.5% (p=0.241). Loss to follow-up was substantial and unequal (6/40 vs 11/40); using observed denominators, recurrence was 0/34 vs 3/29 (p=0.092). Operative time (31.0±2.79 vs 37.9±3.45 min) and hospital stay (2.3±0.6 vs 3.1±1.2 days) were shorter (p<0.05). No deaths occurred in either group. Conclusion: in this small, non-randomised and confounded study, minimal fixation was associated with consistently lower complication rates, yet no difference was statistically reliable; the findings are hypothesis-generating only and do not demonstrate the superiority of fixation.