Short Term Outcomes of Laparoscopic Totally Extraperitoneal Repair of Uncomplicated Groin Hernia Using Polyester Anatomical Mesh Without Fixation
Journal of Surgery
Volume 5, Issue 6, December 2017, Pages: 86-92
Received: Sep. 25, 2017; Accepted: Sep. 29, 2017; Published: Nov. 6, 2017
Views 2085      Downloads 148
Hamdy Sedky Abdalla, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Sherief Abd-Alfattah Saber, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Ahmad Waheed Al-Zayady, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Mohammad Hamdy Abo-Ryia, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Sherif Abd-Alaziem Mustafa, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Gamal Ibrahim Moussa, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Article Tools
Follow on us
Background: Totally extraperitoneal (TEP) repair of groin hernia can be performed with or without mesh fixation. Fixation can result in postoperative pain or paresthesia due to nerve entrapment. Compared to polypropylene mesh, polyester anatomical mesh (Parietex®, Covidien, Mansfield, MA, USA) has a special configuration to fit the posterior inguinal anatomy. Also, the polyester-based chemistry and the rapidly absorbable biological coating increase the hydrophilicity of the mesh, which is thought to result in a fast and intimate tissue ingrowth that may obviate the need for fixation. Patients and Methods: Laparoscopic TEP repair using Parietex® anatomical mesh without fixation was performed for 60 patients presenting with 63 uncomplicated groin hernias. Results: All patients were males with a mean age of 44.7±14.75 years. There were 60 (95.3%) primary, 3 (5%) bilateral inguinal and 2 (3.3%) femoral hernias. The mean operative time was 64.8±22.6 minutes. There were no major operative complications or conversions to transabdominal preperitoneal or open repair. In the early postoperative period, 54 patients (90%) had mild or no pain. Nine patients (15%) developed minor postoperative complications. The mean length of hospital stay was 1.1±0.3 days and the mean time of return to normal daily activities and to work was 2.6±0.64 and 7.15±1.13 days respectively. No patient developed chronic groin pain, mesh-related complications or recurrences during the study period. Ninety one percent of patients described their satisfaction with surgery as good or excellent. Conclusion: laparoscopic TEP repair of uncomplicated groin hernia using Parietex® anatomical mesh without fixation is safe and does not increase the risk of hernia recurrence.
Groin, Hernia, Parietex, Mesh, Laparoscopy, TEP
To cite this article
Hamdy Sedky Abdalla, Sherief Abd-Alfattah Saber, Ahmad Waheed Al-Zayady, Mohammad Hamdy Abo-Ryia, Sherif Abd-Alaziem Mustafa, Gamal Ibrahim Moussa, Short Term Outcomes of Laparoscopic Totally Extraperitoneal Repair of Uncomplicated Groin Hernia Using Polyester Anatomical Mesh Without Fixation, Journal of Surgery. Vol. 5, No. 6, 2017, pp. 86-92. doi: 10.11648/j.js.20170506.11
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Jain SK, Gupta A, Kumar S and Kaza RCM (2014) Laparoscopic vs. open inguinal hernia repair: A systematic review of literature. Asian J Med Sci 5:10-14.
Pahwa HS, Kumar A, Agarwal P, and Agarwal AA (2015) Current trends in laparoscopic groin hernia repair: A review. World J Clin Cases 3 (9): 789-792.
Shouldice E (2003) The Shouldice repair for groin hernias. Surg Clin North Am 83: 1163-1187.
Amato B1, Moja L, Panico S, Persico G, Rispoli C, Rocco N, Moschetti I (2009) Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev, DOI: 10.1002/14651858.CD001543.pub4.
Cavazzola L and Rosen M (2013) Laparoscopic versus open inguinal hernia repair. Surg Clin North Am 93: 1269-1279.
Bracale U1, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L (2012) Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 26: 3355-3356.
Basu S, Chandran S, Somers S, Toh SK (2005) Cost effective laparoscopic TEP inguinal hernia repair. Hernia 9: 363-367.
Heikkninen TJ, Haukipuro K, Koivukangas P, Hulkko A (1998) prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus Lichtenstein hernia operation among employed patients. Surg Laparosc Endosc 8: 338–44.
Arregui M, Davis C, Yucel O (1992) Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report. Surg Laparosc Endosc 2:53-58.
McKernan J and Laws H (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26-28.
Misra MC, Bansal VK, Kumar S, Prashant B, Bhattacharjee HK (2008) Total extra-peritoneal repair of groin hernia: prospective evaluation at a tertiary care center. Hernia 12: 65–67.
Lau H and Patil NG (2004) Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: Multivariate analysis of predictive factors. Surg Endosc 18: 92-96.
Lepere M, Benchetrit S, Debaert M, B Detruit, Dufilho A, Gaujoux D, J Lagoutte, Martin Saint Leon L, Pavis d'Escurac X, Rico E, Sorrentino J, and Therin J (2000) A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using Parietex® meshes. JSLS 4: 147-153.
Weyhe D1, Belyaev O, Müller C, Meurer K, Bauer KH, Papapostolou G, Uhl W. (2007) Improving outcomes in hernia repair by the use of light meshes - a comparison of different implant constructions based on a critical appraisal of the literature. Word J Surg 31 (1): 234-244.
Morales-Conde S (2016) Complications after total endoscopic preperitoneal (TEP) repair in: complications in laparoscopic surgery A guide to prevention and management, Edited by Avci C and Schiappa J. Springer, Switzerland (6):81-92.
Eriksen JR, Gögenur I and Rosenberg J (2007) Choice of mesh for laparoscopic ventral hernia repair. Hernia 11 (6): 481-492.
Champault G, Bernard C, Rizk N and Polliand C (2007) Inguinal hernia repair: the choice of prosthesis outweighs that of technique. Hernia 11 (2): 125-128.
Muller M, Klinge U, Conze J, Shumpelick V (1998) Abdominal wall compliance after Marlex mesh implantation for incisional hernia repair. Hernia 20: 113-117.
Abiad F, Voeller G, Wilson R, Mason E. (2003) Polyester (Parietex) mesh for total extraperitoneal laparoscopic inguinal hernia repair Initial experience in the United States. Surg Endosc 17: 498–501.
Cu EG, Katara AN, Domino JP, Wong HB, So JB, Lomanto D, Cheah WK (2010) Comparison between anatomical polyester (Parietex) mesh and polypropylene (Prolene) mesh with fixation in total extraperitoneal repair for inguinal hernia. Asian J Endosc Surg 3 (3): 137-139.
McCormack K, Grant A and Scott N (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev, DOI: 10.1002/14651858.CD001785.
Klinge U, Klosterhalfen B, Muller M, Ottinger AP, Schumpelick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164 (12): 965-969.
Moreno-Egea A, Torralba JA, Morales CG, Aguayo Albasini JL. (2004) Randomized clinical trial of fixation vs nonfixation of mesh in total extraperitoneal inguinal hernioplasty. Arch Surg 139 (12): 1376 –1379.
Lowham AS, Filipi CJ, Fitzgibbons RJ, R Stoppa R, Wantz GE, Felix EL, and Crafton WB (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair. Ann Surg 225: 422–431.
Tetik C, Arregui ME, Dulucq JL, Fitzgibbons RJ, Franklin ME, McKernan JB, Rosin RD, Schultz LS, Toy FK (1994) Complications and recurrences associated with laparoscopic repair of groin hernias: a multi-institutional retrospective analysis. Ann Surg (8): 1316-1323.
Khajanchee Y, Urbach D, Swanstrom L, Hansen PD (2001) Outcomes of laparoscopic herniorrhaphy without fixation of mesh to the abdominal wall. Surg Endosc 15 (10): 1102-1107.
Rajinder P, Kumar R, Hazrah P, Bal S (2005) A randomized comparison of the early outcome of stapled and unstapled techniques of laparoscopic total extraperitoneal inguinal hernia repair. JSLS (9): 403-407.
Garg P, Rajagopal M, Varghese V, Ismail M (2009) Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 23: 1241-1245.
Beattie G, Kumar S and Nixon S (2000) Laparoscopic total extraperitoneal hernia repair mesh fixation is unnecessary. J Laparoendosc Adv Surg Tech 10 (2): 71-73.
Chowbey P, Kockerling F and Lomanto D (2011) Technical key points: total extraperitoneal patch plasty (TEP) repair In: Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society] (IEHS) Bittner R, Arregui M, Bisgaard T et al Surg Endosc (3):2790-2797.
Fortelny R, Renpold W and Montgomery A (2015) Mesh fixation modalities: is there an association with acute or chronic pain? In: Update guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society), edited by Bittner R, Montgomery M, Bansal V et al. Surg Endosc (9): 303-205.
Roig M, Bertomeu C, Delgado MC, Espinosa RG, Santafé AS, Giner MC (2011) Pain, analgesic consumption and daily activities recovery in patients undergoing ambulatory totally extra-peritoneal laparoscopic inguinal hernioplasty versus ambulatory lichtenstein hernioplasty. Cir Esp 89 (8): 524-531.
Nienhuijs S, Staal E, Strobe L, Rosman C, Groenewoud H, Bleichrodt R (2007) chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194 (3): 394-400.
Akolekar D, Kumar S, Khan L de Beaux AC, Nixon SJ (2008) Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs. Hernia 12: 39-43.
Sajid MS, Kalra L, Parampalli U, Sains PS, Baig MK (2013) A systematic review and meta-analysis evaluating the effectiveness of lightweight mesh against heavyweight mesh in influencing the incidence of chronic groin pain following laparoscopic inguinal hernia repair. Am J Surg 205 (6): 726–736.
Taylor C, Layani L, Liew V, Ghusn M, Crampton N (2008) Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomized clinical trial. Surg Endosc 22:757-62.
Novik B, Hagedom S, Mork UB, Dahlin K, Skullman S, Dalenbäck J (2006) Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study with a 40-month prospective follow-up period. Surg Endosc 20: 462-467.
Staerkle R, Buchli C, and Villiger P (2009) Patient satisfaction, hernia recurrence rate, and chronic pain 10 years after endoscopic total extraperitoneal inguinal hernia repair. Surg Laparosc Endosc Percutan Tech (19): 405–409.
McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systemic review of effectiveness and economic evaluation. Health Technol Assess (9): 201–203.
Lal P, Kajla RK, Chander J, Saha R, Ramteke VK (2003) Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc (17): 850-856.
Kouhia S, Huttunen R, Silvasti S Kouhia ST, Huttunen R, Silvasti SO, Heiskanen JT, Ahtola H, Uotila-Nieminen M, Kiviniemi VV, Hakala T (2009) Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia: a prospective randomized trial. Ann Surg (249): 384–387.
Koch C, Greenlee S, Larson D et al (2006) Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. JSLS 10: 457-460.
Schmedt C, Sauerland S and Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2): 188-199.
Pawanindra L., Kajla R., Chander J., et al (2003) Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc (17):850–856.
Fujita F, Lahmann B, Otsuka K, Lyass S, Hiatt JR, Phillips EH (2004) Quantification of pain and satisfaction following laparoscopic and open hernia repair. Arch Surg (139):596-602.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186