Use of an anatomical self-gripping Progrip™ laparoscopic mesh in TAPP hernia repair. Possible standard? Preliminary results of a prospective study

By common perspective, it is generally considered that laparoscopic inguinal hernia repairs (LIHR) are comparable to conventional operative methods, as an equivalent treatment methodology in the management of inguinal hernias. The results of current studies, however, favour an LIHR in comparison to an open mesh repair (OMR) in selected patient populations. The advantages of LIHR lie in the clearer view of the spermatic cord contents it offers, and, as a result, it is a safer method in the preservation of testicular function, with fewer incidences of acute and chronic pain, and a significantly better quality of life postoperatively in comparison to OMR. One of the last unexplained questions regarding LIHR techniques (especially concerning the transabdominal preperitoneal inguinal hernia repair (TAPP) operation) was with regards to the fixation of the mesh. The goal of this study, based on single-centre prospective collection of data from the Internet-based multicentre Herniamed® register, is to demonstrate the safety and efficacy of the use of Parietex™ ProGrip™ Laparoscopic mesh in standardized LIHR with the TAPP technique.

Data analysis encompassed all patients who underwent inguinal hernia surgery within the period from May 1, 2013 to December 31, 2014, who fulfilled the inclusion criteria. There were two surgeons with experience in this particular technique contributing on the surgeries. Data were entered and subsequently analysed on the Herniamed® platform. All patients were managed in compliance with a standard protocol and were then re-evaluated 1 and 12 months postoperatively with a standardized questionnaire. Patients with a fixed scrotal hernia or an American Society of Anesthesiologists (ASA) stage IV were excluded from the study.

In total, 95 patients were listed in the prospective, completely processed documentation on the Herniamed® platform. In total, 156 hernias were operated on. From the demographic point of view, there were 85 men (89.47 %) and 10 women (10.53 %). Representation of females in the group was around one-tenth: 10/95 (10.53 %), while these were mostly bilateral hernias. The average operation time was 64 min, while time taken for bilateral hernias was 67 min. Majority of operated hernias, i. e. 143 hernias (91.67 %) had hernia openings of moderate and large sizes (types 2 and 3, >1.5 cm and <4 cm); medial hernias were predominant on both sides. During the surgery, no complications were demonstrated; postoperative complications were evaluated as significant in relation to previous surgical procedures (major) and as less significant (minor), which did not influence the duration of hospitalization, and these were managed conservatively on an outpatient basis. Postoperative pain of moderate degree (4–6 Visual analogue scale [VAS]) lasting over 3 months in the groin was reported in one case (1.05 %). At the 1‑year assessment, mild discomfort was reported in the groin in 2 from 57 patients (3.51 %), which had no effect on any patient’s usual activity and did not require any therapy (1–3 VAS). After 1 year, there was no patient with chronic postherniorrhaphy inguinal pain (CPIP) reported. There was no recurrence of inguinal hernia confirmed in the followed-up group.

The legitimacy of the use of the self-fixation mesh was demonstrated in an experiment, in open inguinal hernia repair, laparoscopic totally extraperitoneal hernioplasty (TEP) technique and in TAPP technique. Our study demonstrates that LIHR using the TAPP technique with implantation of a new Parietex™ ProGrip™ laparoscopic self-fixation mesh is a fast, effective and reliable method in experienced hands, which combines the advantages of laparoscopic approach with simple and practical implantation of self-fixation mesh, which, according to our results, reduces the occurrence of CPIP and the recurrence rate.