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Aug 2011

Fixing the Mesh in Inguinal Hernia Repair: Where Do We Stand?

Author Affiliations

Author Affiliations: MM Institute of Medical Sciences and Research, Minimally Access Surgery, Mullana (Dr Garg), and Chaudhary Devi Lal University, Sirsa (Dr Nain), Haryana, India.

Arch Surg. 2011;146(8):992-993. doi:10.1001/archsurg.2011.190

We congratulate Novik et al1 for publishing such a remarkable study. Data from such a large population registry provides valuable insight into mesh fixation in open hernia repair. There is a tendency toward using glue or absorbable sutures and avoiding nonabsorbable sutures in open repair to reduce the incidence of chronic pain. The results of this study1 raise pertinent questions regarding the fixation of mesh with glue. A recent study2 demonstrated that patients who received glue to fix the mesh experienced significantly less pain, numbness, and discomfort compared with patients who received suture fixation of the mesh; however, most of these patients had a short follow-up period of approximately 1 year. Because the effect of fixation of mesh with glue can be, at best, equivalent to fixation with short-term absorbable sutures, the value of a long-term follow-up period in such studies becomes marked. Therefore, the results of the studies using glue to fix the mesh in open hernia repair should be taken with caution. Second, several studies have demonstrated the safety (recurrence rate) of nonfixation of mesh in laparoscopic total extraperitoneal repair. Studies with a large number of patients with a long follow-up period3 and meta-analysis4 have confirmed this. What could be the possible explanation for this? As a corollary, from the results of the present study,1 would it be reasonable to conclude that open hernia repair with nonfixation of mesh by any means (eg, sutures or glue, as in total extraperitoneal repair) is bound to fail and should never be tried?

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