Selective Non-Stapling of Mesh during Unilateral Endoscopic Total Extraperitoneal Inguinal Hernioplasty: A Case-Control Study

Abstract

Hypothesis: Selective non-stapling of the mesh during unilateral endoscopic total extraperitoneal inguinal hernioplasty (TEP) may reduce postoperative pain and morbidity rate. Design: Case-control study. Setting: Division of general surgery at a university-affiliated teaching hospital. Patients: Two hundred patients who underwent TEP. Intervention: Endoscopic total extraperitoneal inguinal hernioplasty with and without stapling the mesh. The mesh was stapled when the diameter of the hernial defect was greater than 4 cm or there was an inadequate overlap of the defect by the mesh. Main Outcome Measures: Postoperative pain score and morbidity rate were compared between patients who had stapling and selective non-stapling of the mesh during TEP. Results: Demographic features, hernia types, and mean operative times of the 2 groups were comparable. Postoperative pain scores upon coughing from the day of operation to postoperative day 6 were lower in patients who had not had the mesh stapled, but the difference was not statistically significant. Comparisons of the mean length of hospital stay, postoperative morbidity, and time taken to resume normal activities showed no significant difference between the 2 groups. With a mean follow-up of 1 year, no neuralgia or recurrence was noted in either group during follow-up. Conclusions: Selective non-stapling of the mesh did not confer short-term benefits, such as reduced postoperative pain and morbidity, compared with those who had routine stapling of the mesh during TEP. For patients with a hernial defect measuring less than 4 cm, TEP can be performed without stapling the mesh. The selective non-stapling strategy also helps to reduce the cost of the operation and the potential for nerve entrapment.