What are the best mesh options for inguinal hernia repair?

Abstract

<h4>Introduction</h4>Laparoscopic repair has become the preferred approach for inguinal hernia due to its lower post-operative morbidity and faster recovery. However, the choice of mesh fixation remains a topic of debate. Self-adhesive meshes were developed to eliminate the need for mechanical fixation, aiming to reduce post-operative pain, though their long-term outcomes compared to traditional tacker fixation are still under investigation. This study aimed to compare recurrence rates and post-operative outcomes between self-adhesive and tacker-fixed polypropylene meshes in transabdominal preperitoneal (TAPP) inguinal hernia repair.<h4>Patients and methods</h4>An observational cohort study including 400 patients who underwent TAPP laparoscopic repair between 2018 and 2023 in hospitals across Rio de Janeiro, Brazil. Demographic variables, hernia laterality, mesh type, complications and recurrence were recorded. Fisher's exact test and linear regression were used. P ≤ 0.05 was considered significant. Follow-up was 3 months.<h4>Results</h4>The sample consisted predominantly of males (89.5%), with bilateral hernias being the most common presentation (51.25%). Self-adhesive mesh was used in 72.5% of cases, and polypropylene mesh with tacker fixation in 27.5%. The overall recurrence rate was 6%, with no significant difference between mesh types (P = 0.249). The global complication rate was 4.25%, mainly post-operative pain (3.0%) and seroma (0.75%), with no significant differences between groups.<h4>Conclusions</h4>Self-adhesive and tacker-fixed polypropylene meshes demonstrated comparable recurrence and complication rates in TAPP repair. Self-adhesive meshes remain a safe alternative that eliminates the need for mechanical fixation, although longer follow-up studies are required to assess late recurrence and long-term outcomes.