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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 13
Original paper

Comparison of slit mesh versus nonslit mesh in laparoscopic extraperitoneal hernia repair

Dogan Yildirim, Turgut Donmez, Halim Ozcevik, Mikail Cakir, Suleyman Demiryas, Okan Murat Akturk

Videosurgery Miniinv 2018; 13 (4): 469–476
Online publish date: 2018/07/24
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Endoscopic hernia repair integrates the advantages of tension-free preperitoneal mesh support of the groin with the advantages of minimally invasive surgery procedures.

To compare outcomes between slit mesh (SM) and nonslit mesh (NSM) placement in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Material and methods
This is a retrospective study of 353 patients who underwent TEP inguinal hernia repair between January 2010 and December 2011. One hundred forty-nine and 154 hernias were operated on in the SM and NSM groups, respectively. Postoperative complications, recurrence, early postoperative pain, and chronic pain levels were evaluated.

In a total of 303 patients, hernia repair was performed as 395 direct and indirect hernias. Nonslit mesh was converted from TEP to transabdominal preperitoneal patch plasty (TAPP) in 4 patients in the group and 6 patients in the slit mesh group. The average operation time of the SM group was significantly higher than that of the NSM group (p < 0.001). In the evaluation of early postoperative pain, VAS levels of the NSM group were statistically significantly lower than those of the SR group in all evaluations (p = 0.001). The pain rate of the SM group after 3 months of chronic pain was significantly higher than that of the NSM group (p = 0.004). There was no difference in recurrence rate, 6th month chronic pain, wound infection or wound hematoma.

The use of SM and NSM in TEP operations is not different in terms of recurrence and complications. However, the use of NSM gives better results in terms of early postoperative pain and chronic pain.


total extraperitoneal, groin hernia, slit mesh, nonslit mesh

Belyansky I, Tsirline VB, Klima DA, et al. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg 2011; 254: 709-14.
Mitura K, Romanczuk M. Redundant modifications of Lichtenstein technique in hernia repair – a descriptive study of practicing surgeons in Poland. Videosurgery Miniinv 2009; 4: 1-5.
Scott NW, McCormack K, Graham P, et al. Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 2002; 4: CD002197.
Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernias. N Eng J Med 2004; 350: 1819-27.
McCormick K, Scott NW, Go PM, et al.; EU Hernia Trialists Collaboration. Laparoscopic technique versus open technique for inguinal hernia repair. Cochrane Database Syst Rev 2003; 1: CD001785.
Swanstrom L. Laparoscopic surgery: laparoscopic herniorrhaphy. Surg Clinics North Am 1996; 73: 483-91.
Staarink M, van Veen RN, Hop WC, Weidema WF. A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 2008; 22: 1803-6.
Arregui ME, Young SB. Groin hernia repair by laparoscopic techniques: current status and controversies. World J Surg 2005; 29: 1052-7.
Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25: 2773-843.
Leibl BJ, Schmedt CG, Schwarz J, et al. A single institution’s experience with transperitoneal laparoscopic hernia repair. Am J Surg 1998; 175: 446-52.
Chia CL, Su J, Hoe Y, et al. Outcomes of slit mesh in laparoscopic totally extraperitoneal inguinal hernia repair: does it affect recurrence? Asian J Endosc Surg 2015; 8: 434-8.
Fitzgibbons RJ Jr, Puri V. Laparoscopic inguinal hernia repair. Am Surg 2006; 72: 197-206.
[No authors listed] Laparoscopic versus open repair of groin hernia: a randomized comparison. The MRC Laparoscopic Groin Hernia Trial Group. Lancet 1999; 354: 185-90.
Korman JE, Hiatt JR, Feldmar D, Phillips EH. Mesh configurations in laparoscopic extraperitoneal herniorrhaphy. A comparison of techniques. Surg Endosc 1997; 11: 1102-5.
Messenger DE, Aroori S, Vipond MN. Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients. Ann R Coll Surg Engl 2010; 92: 201-5.
Napier T, Olson JT, Windmiller J, Treat J. A long-term follow-up of a single rural surgeon’s experience with laparoscopic inguinal hernia repair. WMJ 2008; 107: 136-9.
Weyhe D, Meurer K, Belyaev O, et al. Do various mesh placement techniques affect the outcome in totally extraperitoneal hernia repair? What is the role of the surgeon? J Laparoendosc Adv Surg Tech 2007; A17: 749-57.
Domniz N, Perry ZH, Lantsberg L, et al. Slit versus non-slit mesh placement in total extraperitoneal inguinal hernia repair. World J Surg 2011; 35: 2382-6.
Bittner R, Montgomery MA, Arregui E, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 2015; 29: 289-321.
Stengel D, Bauwens K, Ekkernkamp A. Recurrence risks in randomized trials of laparoscopic versus open inguinal hernia repair: to pool or not to pool (this is not the question). Langenbecks Arch Surg 2004; 389: 492-8.
Arvidsson D, Berndsen FH, Larsson LG, et al. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus shouldice repair of primary inguinal hernia. Br J Surg 2005; 92: 1085-91.
Eklund AS, Montgomery A, Rasmussen C, et al. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair. A randomized, multicenter trial with 5-year follow-up. Ann Surg 2009; 249: 33-8
International Association for the Study of Pain. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986; 3: S1-226.
Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005; 95: 69-76.
Mitura K, Śmietański M, Kozieł S, et al. Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients. Hernia 2018 Apr 26. doi: 10.1007/s10029-018-1774-4 (Epub ahead of print).
Berndsen FH, Petersson U, Arvidsson D, et al. Discomfort five years after laparoscopic and shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group. Hernia 2008; 11: 307-13.
Poobalan AS, Bruce J, Smith WC, et al. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 2003; 19: 48-54.
Ersin S, Aydin U, Makay O, et al. Is testicular perfusion influenced during laparoscopic inguinal hernia surgery? Surg Endosc 2006; 20: 685-9.
Lau H, Lee F. Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 2003; 17: 1773-7.
Krishna A, Misra MC, Bansal VK, et al. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 2012; 26: 639-49.
Lepere M, Benchetrit S, Debaert M, et al. A multicentric comparison of transabdominal versus totally extraperitoneal laparoscopic hernia repair using PARIETEX meshes. JSLS 2000; 4: 147-53.
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