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Fortelny. Mini-invasive Surg 2021;5:16 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.21

Review Open Access

Is mesh fixation in TAPP and TEP still necessary?

René H. Fortelny

Department of General Surgery, Medical Faculty, Sigmund Freud PrivateUniversity, Vienna A1020, Austria.
Correspondence to: Dr. René H. Fortelny, Department of General Surgery, Head of General Surgery, Medical Faculty, Sigmund
Freud PrivateUniversity, Freudplatz 3, A1020 Vienna, Austria. E-mail: dr.fortelny@gmail.com
How to cite this article: Fortelny RH. Is mesh fixation in TAPP and TEP still necessary? Mini-invasive Surg 2021;5:16.
https://dx.doi.org/10.20517/2574-1225.2021.21
Received: 18 Feb 2021 First Decision: 25 Feb 2021 Revised: 5 Mar 2021 Accepted: 9 Mar 2021 Available online: 8 Apr 2021

Academic Editor: William W. Hope Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
One of the most serious complications after inguinal hernia repair is still the occurrence of chronic pain. The
literature describes rates of severe chronic pain of 3%-6%. Laparo-endoscopic inguinal hernia repair is favored to
prevent postoperative pain through a minimally invasive approach and sparing of the layers of tissue covering
nerves and vessels in terms of reduced risk of damage to these structures. However, the method of fixation of the
mesh is still controversial discussed. The use of these penetrating devices such as staples and staplers has been
shown to often be complicated by injury to nerves and vessels and occurrence of postoperative pain. The shift to
completely atraumatic fixation using adhesives (fibrin glue, cyanoacrylate) began in the early part of this century.
Several studies confirmed less postoperative pain after mesh fixation by glue compared to stapler or tacker.
Historically, the TEP technique has always been performed without any fixation. Several studies comparing fixation
versus non-fixation have been performed in TEP repair and found results with no increase in recurrence rate.
Notwithstanding that very few studies comparing fixation versus no fixation with exclusion of large medial inguinal
hernias have been published on this topic in TAPP repair, identical results to those with TEP repair were obtained.
On the basis of current evidence, no mesh fixation is recommended for laparo-endoscopic inguinal hernia repair
except for large medial and combined inguinal hernias. If mesh fixation is required, atraumatic techniques should
be used.

Keywords: Laparo-endoscopic inguinal hernia repair, TAPP, TEP, mesh fixation, non-fixation, atraumatic fixation,
glue fixation

INTRODUCTION
Since the introduction of minimally invasive techniques in inguinal hernia surgery with TAPP and TEP ,
[1]
[2]

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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