Laparoscopic total extraperitoneal hernia repair: Mesh fixation is unnecessary

Background: Inguinal hernia repair contributes significantly to the general surgeon's workload. Since the evolution of laparoscopic inguinal hernia re pair, the total extraperitoneal (TEP) repair is the technique most commonly employed by laparoscopic surgeons. This technique involves the placement o f a polypropylene mesh in the preperitoneal space. The issue of fixation of this mesh remains unresolved. Surgeons have previously fixed this mesh in place using laparoscopic stapling devices, suturing techniques, or, more re cently, polycyanoacrylate adhesives. However, stapling the mesh not only in creases the time and expense of the procedure but can cause specific compli cations such as nerve entrapment syndromes and osteitis pubis. Patients and Methods: We report a series of 89 total extraperitoneal laparo scopic repairs in 80 consecutive patients using no means of mechanical or a dhesive mesh fixation, irrespective of the size of the hernial defect. Results: Follow-up revealed no increase in morbidity or hernia recurrence. Conclusion: Our experience suggests that mechanically fixing the mesh in th e preperitoneal space is unnecessary. Not fixing the mesh avoids possible c omplications and is not associated with any increased risk of hernia recurr ence.