Evidence-Based Optimal Fixation During Laparoscopic Hernia Repair: Sutures, Tacks, and Glues
Mesh fixation during ventral and inguinal hernia repair is a critical step which should aim to secure the mesh in place to prevent recurrence of hernia while promoting rapid ingrowth and reducing associated complications, pain, formation of adhesions, and mesh shrinkage. The purpose of this chapter is to provide an up-to-date and evidence-supported review of fixation products and techniques in laparoscopic ventral and inguinal hernia repair.
The authors conducted a literature search using PubMed Database, from year 1990 to current, using the following terms: mesh; fixation; tacks; sutures, adhesives, inguinal hernia, ventral hernia, laparoscopic repairs. All relevant retrospective and prospective studies were reviewed and included for writing of this chapter.
Additionally, authors describe their own experience and practice with regard to mesh fixation in the laparoscopic repair of inguinal and ventral hernias.
Seventeen various devices used for mesh fixation are described, divided into four categories: Nonabsorbable tacks, absorbable tacks, sutures, and glues.
While there is some indication that sutures add additional stability to fixation of mesh, they may also be associated with more acute and chronic pain. Tacks and staples may reduce pain compared to sutures, but may not prevent mesh shrinkage and migration and are more invasive than glue fixation. Glue fixation which has not been definitively shown to be inferior to other fixation modalities, although data indicates its trend towards higher recurrence rates.
Overall, the current literature does not consistently support any particular fixation technique as superior. Selecting the right mesh fixation device and technique must take into consideration the type of hernia, size of defect, type of mesh, and patient anatomy.
KeywordsVentral hernia Inguinal hernia Laparoscopic repair Mesh Fixation device Sutures Tacks Adhesives Absorbable Nonabsorbable
We would like to thank Mr. Ivan George and Mr. Paxton Paganelli for all their help and efforts in preparing our graphics and figure illustrations.
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