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Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia

Introduction: The advent of laparoscopic techniques in repairing inguinal hernia has significantly improved outcomes of inguinal hernia surgery. However, acute and chronic postoperative pain after fixation of mesh with tacks and the cost of tacking devices are major hindrances to the widespread use...

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Autores principales: Aziz, Sarmad S, Jan, ZakaUllah, Ijaz, Nadeem, Zarin, Mohammad, Toru, Hamza K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372384/
https://www.ncbi.nlm.nih.gov/pubmed/35971369
http://dx.doi.org/10.7759/cureus.26821
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author Aziz, Sarmad S
Jan, ZakaUllah
Ijaz, Nadeem
Zarin, Mohammad
Toru, Hamza K
author_facet Aziz, Sarmad S
Jan, ZakaUllah
Ijaz, Nadeem
Zarin, Mohammad
Toru, Hamza K
author_sort Aziz, Sarmad S
collection PubMed
description Introduction: The advent of laparoscopic techniques in repairing inguinal hernia has significantly improved outcomes of inguinal hernia surgery. However, acute and chronic postoperative pain after fixation of mesh with tacks and the cost of tacking devices are major hindrances to the widespread use of laparoscopic transabdominal preperitoneal (TAPP) repair in resource-poor settings. This study sought to introduce a method of mesh fixation that will reduce the cost of laparoscopic TAPP repair and might help reduce postoperative pain. Objective: To compare outcomes in the early postoperative period like pain, seroma, hematoma, urinary retention, and neuralgia after fixation with suture versus the tack fixation of mesh in laparoscopic TAPP repair of inguinal hernia.  Subjects and methods: This study was conducted from 1(st )June 2019 to 31(st) May 2020. A total of 144 patients between ages 18 and 60 years with an inguinal hernia on any side and having an American Society of Anaesthesiologists (ASA) score of I/II were included in this study. Patients with a recurrent hernia, large scrotal hernia, strangulated and obstructed hernias, ASA III and ASA IV, prostatism, and chronic cough were excluded. Seventy-two patients were in Group A (tack fixation group) while 72 were in Group B (suture fixation group). Separate investigators were assigned to collect pre-operative and post-operative data from both groups, recorded on specially designed proforma. Results: The age range was 18 to 60 years with a mean age of 46.53 years ±10.01 S.D in Group A and 46.19 ±9.58 S.D in Group B. In Group A 98.6% of patients were male, and 1.4% were females while in Group B 100% of patients were male. It was found that mean pain in Group A was 4.88 ±0.887 and 5.29± 0.777 at 6 hours and 24 hours respectively. Mean pain in group B was 3.43 ±0.962 and 4.11±0.703 at 6 hours and 24 hours respectively. Moreover, mean pain in Group B was significantly less than mean pain in Group A both at 6 hours and 24 hours intervals with a p-value < 0.001. The early postoperative complications were not significantly different in both groups.  Conclusion: In TAPP repair, suture fixation of mesh is less painful than tack fixation. However, there is no significant difference in the rate of other early postoperative outcomes like seroma, hematoma, urinary retention, and neuralgia. Further multicentric studies with a longer duration of follow-up are needed to validate our results.
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spelling pubmed-93723842022-08-14 Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia Aziz, Sarmad S Jan, ZakaUllah Ijaz, Nadeem Zarin, Mohammad Toru, Hamza K Cureus General Surgery Introduction: The advent of laparoscopic techniques in repairing inguinal hernia has significantly improved outcomes of inguinal hernia surgery. However, acute and chronic postoperative pain after fixation of mesh with tacks and the cost of tacking devices are major hindrances to the widespread use of laparoscopic transabdominal preperitoneal (TAPP) repair in resource-poor settings. This study sought to introduce a method of mesh fixation that will reduce the cost of laparoscopic TAPP repair and might help reduce postoperative pain. Objective: To compare outcomes in the early postoperative period like pain, seroma, hematoma, urinary retention, and neuralgia after fixation with suture versus the tack fixation of mesh in laparoscopic TAPP repair of inguinal hernia.  Subjects and methods: This study was conducted from 1(st )June 2019 to 31(st) May 2020. A total of 144 patients between ages 18 and 60 years with an inguinal hernia on any side and having an American Society of Anaesthesiologists (ASA) score of I/II were included in this study. Patients with a recurrent hernia, large scrotal hernia, strangulated and obstructed hernias, ASA III and ASA IV, prostatism, and chronic cough were excluded. Seventy-two patients were in Group A (tack fixation group) while 72 were in Group B (suture fixation group). Separate investigators were assigned to collect pre-operative and post-operative data from both groups, recorded on specially designed proforma. Results: The age range was 18 to 60 years with a mean age of 46.53 years ±10.01 S.D in Group A and 46.19 ±9.58 S.D in Group B. In Group A 98.6% of patients were male, and 1.4% were females while in Group B 100% of patients were male. It was found that mean pain in Group A was 4.88 ±0.887 and 5.29± 0.777 at 6 hours and 24 hours respectively. Mean pain in group B was 3.43 ±0.962 and 4.11±0.703 at 6 hours and 24 hours respectively. Moreover, mean pain in Group B was significantly less than mean pain in Group A both at 6 hours and 24 hours intervals with a p-value < 0.001. The early postoperative complications were not significantly different in both groups.  Conclusion: In TAPP repair, suture fixation of mesh is less painful than tack fixation. However, there is no significant difference in the rate of other early postoperative outcomes like seroma, hematoma, urinary retention, and neuralgia. Further multicentric studies with a longer duration of follow-up are needed to validate our results. Cureus 2022-07-13 /pmc/articles/PMC9372384/ /pubmed/35971369 http://dx.doi.org/10.7759/cureus.26821 Text en Copyright © 2022, Aziz et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle General Surgery
Aziz, Sarmad S
Jan, ZakaUllah
Ijaz, Nadeem
Zarin, Mohammad
Toru, Hamza K
Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
title Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
title_full Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
title_fullStr Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
title_full_unstemmed Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
title_short Comparison of Early Outcomes in Patients Undergoing Suture Fixation Versus Tack Fixation of Mesh in Laparoscopic Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
title_sort comparison of early outcomes in patients undergoing suture fixation versus tack fixation of mesh in laparoscopic transabdominal preperitoneal (tapp) repair of inguinal hernia
topic General Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372384/
https://www.ncbi.nlm.nih.gov/pubmed/35971369
http://dx.doi.org/10.7759/cureus.26821
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