Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair - A prospective randomized trial

Background: Controversy exists regarding whether it is necessary to secure the mesh prosthesis during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. It is unknown whether stapling the mesh affects re currence rate, incidence of neuralgia, or port-site hernia. Methods: We conducted a prospective randomized trial comparing stapled with nonstapled laparoscopic TAPP inguinal hernia repairs in a series of 502 co nsecutive patients undergoing elective inguinal hernia repair at two instit utions between January 1995 and March 1997. Results: In all, 263 nonstapled and 273 stapled repairs were performed in 5 02 patients. Patients were evaluated at a median follow-up of 16 months (ra nge, 1-32 months) by independent surgeons. There was no statistical differe nce in the incidence of recurrence (0 to 263 nonstapled, 3 to 273 stapled; chi-square p = 0.09). The overall recurrence rate was 0.6%. There was no si gnificant difference in operative time, port-site hernia, chronic pain or n euralgia between the two groups. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair, allowing a reduction in the size of the ports.