In trans abdominal proproteinial hernioplasty, is it important to fix the mesh??
Have you any experience in , not fixing the mesh??
Fix or not fix, that is the question now. Fixation, make my sleep fine. But in TEP, I do not fix unilateral mesh, if mesh have good position.
I started quite late ( in the last 4 years) the laparoscopic treatment of inguinal hernia when there was a growing interest in glue mesh fixation and was quite obsolete the use of trackers (absorbable and non absorbable). I use only glue . The problem is always the same : to assess the percentage of relapses at medium and long term
I do mostly TEP. I switched from TAP to TEP after doing 61 TAPS and rarely have to do TAP. Started in 1991. I use 7 to 10 pro-tacks per side. I always worry about recurrences on directs that have not had fixation. I find my recurrence rate to be 1 percent or less.
I do both TEP and TAPP. I only fix the large direct hernia with tacker
Unfortunately there is no good data to direct our decision of whether to fixate the mesh in inguinal hernia repair (and if so, with what method). At the University of Washington Hernia Center, we use a self-fixating mesh that seems to remain in good position without tacks or fibrin sealant/glue. We predominantly perform TEP, but I have used this mesh in TAPP on several occasions. Only long-term clinical and radiographic follow-up will allow us to determine whether this type of mesh has an equivalent or lower hernia recurrence rate and helps lower the incidence of chronic inguinodynia by avoiding the use of tacks.
If positioned well, fixation of the mesh in TEP procedure is not necessary. Whereas in TAPP procedure, for large direct hernia, either you should use a larger mesh than a usual one or fix it.
Since training on the da Vinci roobot I have switched almost exclusively to TAPP and decreased significantly the number of TEPs I do. I am training residents to do robotic surgery and have found that it is easier to train them by doing TAPPs. I use about 5 to six vicryl sutures to fixate the mesh. Results appear to be very good. I have been using a 10 X 15 cm Symbotex mesh.
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