yes, if the defect is large, especially direct....tacks should be applied to the defect edge...if otherwise the defect is small, no fixation required in TEP
I think 3-D meshes are specially designed to conform to the inguinal anatomy, and does not need fixation when appropriate size is used even in moderate sized direct inguinal hernias
1. Concerning recurrence risk, the need for mesh fixation depends on the rigidity of the prosthetic device and the size of the hernia defect:
For instance, the original Bard 3D-Max size Large will probably suffice without fixation for just about all groin hernia sizes, whereas we do not yet know the limitations of the Light-version.
2. Another question is of course whether 3D meshes, who by definition are more rigid than plain light-weight mesh sheets, are more inclined to cause chronic foreign body sensation...?
3DMax meshes does not require fixation if a large size is used.They are easy to place and fits well provided retropubic space is opened to place the lower medial end marked M and the tapered lateral end should fit well in to the lateral space created.
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