How I do It: Knot Placement Technique for Self-Gripping Mesh in Totally Extraperitoneal (TEP) Inguinal Hernia Repair

Abstract

Abstract Background Surgical Inguinal hernia repair techniques are constantly evolving. Mesh fixation and placement remain cornerstones of the procedures. The use of self-gripping mesh has shown a significant reduction in postoperative pain and complications. However, technical difficulties arise, and multiple deployment methods have been described, with no consensus. Therefore, in this study, we present a novel preparation, deployment, and placement technique for self-gripping mesh during laparoscopic inguinal hernia repair, with its consequent outcomes and follow-up. Methods The self-gripping mesh is folded in half, non-absorbable sutures are placed in each distal portion and in the middle of the mesh, making sure the knot lies in the non-adherent surface. Corners are rounded. Mesh is rolled using the “tobacco technique”. The mesh is then placed with the laparoscopic grasper inside the preperitoneal cavity and is unrolled from medial to lateral. Results 142 patients underwent totally extraperitoneal (TEP) inguinal hernia repair. Self-gripping mesh (ProgripTM) was used in all cases. 48.6% had bilateral defects. 33 patients underwent additional procedures. Mean time for mesh deployment was 180 seconds. Mean in-hospital stay was 1.6 days. No conversion was necessary. 88.9%, 86% and 36.7% of patients completed one year, 2 years, and 5 years of follow-up respectively. Chronic pain was present in two patients. Conclusion We introduce a new technique for self-gripping mesh preparation, deployment and placement for inguinal hernia repair using the TEP approach. Our technique seems to have satisfactory results regarding long-term follow-up complications.