Two Types of Mesh in TAPP for Primary Inguinal Hernia: A Retrospective Study With Long-Term Follow-Up in Elderly Patients.

Abstract

<h4>Background</h4>The clinical value of self-gripping mesh (SGM) in laparoscopic transabdominal preperitoneal (TAPP) repair for elderly patients with primary inguinal hernia remains unclear. This study aimed to compare the perioperative and postoperative outcomes between SGM and conventional mesh (CM) in this population.<h4>Methods</h4>Patients were divided into 2 groups: the SGM group and the CM group based on the type of mesh used during surgery. Preoperative, intraoperative, and postoperative data were collected and analyzed for 113 elderly patients (aged 60 y or older) with primary unilateral inguinal hernia.<h4>Results</h4>A total of 113 patients who underwent TAPP repair met the inclusion criteria without any exclusion criteria, with 60 in the SGM group and 53 in the CM group. Baseline characteristics, including mean age, sex distribution, body mass index (BMI), hernia type, defects, and location, were comparable between the 2 groups (P>0.05). No significant differences were observed in operative time, intraoperative blood loss, postoperative hospital stay, hospitalization costs, or the incidence of wound or pulmonary infections (P>0.05). However, the SGM group demonstrated a significantly lower postoperative pain score (NRS) (median (Q1/Q3): 1 (1, 2) vs. 3 (2.5, 4), P=0.001) and a reduced incidence of hematoma or seroma (8.33% vs. 20.75%, P=0.034). No cases of postoperative mortality, urinary complications, or mesh infections were observed in either group. Hernia recurrence occurred in 6 patients in the CM group and 1 patient in the SGM group during the follow-up period, though the difference was not statistically significant (1.67% vs. 11.32%, P=0.083). Chronic postoperative pain was significantly less frequent in the SGM group (3.33% vs. 16.98%, P=0.039). Subgroup analysis further revealed that patients with inguinal hernia defects <3 cm, the SGM group demonstrated significantly fewer recurrences compared with the CM group ( 0% vs. 14.29%, P=0.034). Whereas, in patients with defects ≥3 cm, the SGM group had a significantly lower incidence of postoperative hematoma or seroma (6.26% vs. 38.9%; P=0.043) and chronic pain (0% vs. 27.78%; P=0.046) compared with the CM group.<h4>Conclusion</h4>This study demonstrates that usage of SGM significantly reduces both acute and chronic postoperative pain, as well as the incidence of hematoma and seroma, in elderly patients undergoing laparoscopic TAPP repair for primary inguinal hernia. Moreover, SGM was associated with lower rates of both chronic pain and hematoma/seroma in patients with hernia defects ≥3 cm, as well as a lower recurrence rate in those with defects <3 cm. These results support the clinical value of SGM as a favorable mesh option in this population.