Comparison of three-dimensional mesh (3D mesh) without fixation versus polypropylene mesh with fixation in patients of inguinal hernia undergoing totally extraperitoneal repair

INTRODUCTION: We aimed to compare the results of patients who underwent inguinal hernia repair with non-fixation pre-shaped three-dimensional (3D) mesh and fixation with polypropylene meshes (PPM) using the totally extraperitoneal (TEP) method.
METHODS: A total of 96 patients who underwent laparoscopic hernia repair with the diagnosis of inguinal hernia between April 2019 and September 2023 were retrospectively analyzed. The patients were divided into two groups according to the mesh type used: staple fixation (SF) group (n=52), in which light-weight PPM was used, and non-staple fixation (NSF) group (n=44), in which pre-shaped 3D mesh was used. Patients’ age, sex, body mass index (BMI), ASA score, comorbidities, hernia type, Visual Analog Scale (VAS) score at rest (VAS-rest) and while in motion (VAS-act), and chronic groin pain (CGP) were recorded. Postoperative follow-ups were performed at one, four weeks and three, and 12 months.
RESULTS: The surgical time was found to be shorter in NSF group patients than in the SF group (p=0.011). In the SF group, four patients developed seroma, one patient developed urinary retention, and two patients developed hematoma. In the NSF group, seroma developed in three patients, urinary retention developed in two patients, and one hematoma was observed. Recurrence was observed in two patients in the SF group at 10 and 14 months, and in one patient in the NSF group at eight months. In the NSF group, groin pain was found less frequently on Day 1 and at Week 1 than in the SF group, indicating a statistically significant difference (p<0.001 and p<0.001, respectively).
DISCUSSION AND CONCLUSION: Applying pre-shaped 3D mesh without any fixation is a safe and applicable method in inguinal hernia surgery. We recommend this method, as CGP is less than the polypropylene mesh fixation method and does not increase recurrence. This method can be performed by experienced surgeons with low complication rates.