Ahamed Mourad ,Tamer M Said Salama *,Karim Sabry
Recently, it is being suggested in the literature that postoperative pain after TAPP is mostly attributed to the use of staples in mesh fixation .This study aims to compare the value and cost effectiveness of using facial closure needle versus the use of staples in the fixation of prosthetic meshes in laparoscopic tinguinal hernia repair (TAPP).
Sixty male patients suffering from inguinal hernia with a mean age 22.7 years ranging from 18 to 30 years were enrolled in this study mesh fixation using fascial closure needle was done in 30 cases and using staples in another other 30 cases. Full physical assessment for the patients was performed and any postoperative complications such as early or late post-operative pain or burning sensation, hyperesthesia, wound infection, seroma, hematoma or recurrence were recorded.
he mean duration of intervention for fascial needle fixation cases was 43.4 minutes while for stapled cases the mean duration of intervention was 40 minutes. The mean recovery time to normal physical activity was 7.5 days for fascial needle fixation cases and was 9.1 for stapled cases. In stapled patients, one case of recurrence occurred, 2 cases showed hematoma and by the end of the 1st month after the operation, 2 cases had suffered lateral thigh pain, while at the end of the 6th month after the operation 5 cases had suffered chronic inguinal pain. In cases with fascial needle fixation no recurrence had occurred, while 1 case showed subcutaneous port hematoma and one case was reported with inguinal discomfort at the end of the 1st month after the operation and at the end of the 6th month after the operation, no cases had pain
From the above results, we can conclude that the use of fascial needle closure for mesh fixation in TAPP is better than the use of staples, not only because it is associated with lower incidence of postoperative complications (i.e. postoperative pain and recurrence) but also because its associated with lower costs allowing better availability for all patients