Abstract
Purpose
Transabdominal preperitoneal hernia mesh plasty (TAPP) offers significant benefits to patients undergoing bilateral inguinal hernia repair. We evaluated a novel pre-shaped, large-pored, titanium-coated, lightweight polypropylene mesh for bilateral placement as an alternative to two separate meshes.
Methods
Thirty-six patients underwent elective surgical repair of bilateral inguinal hernias with the new mesh at three departments of surgery in Linz and Graz, Austria, between May 1, 2015 and June 30, 2017.
Results
All operations were completed without intraoperative complications or conversion to open procedures. The mean operation time was 74 min. There were no postoperative procedure-related complications with the exception of one hematoseroma of the spermatic cord. Two symptomatic medial recurrences (2/36 patients = 5.6%, 2/72 hernia repairs = 2.8%, respectively) after supravesical and medial hernia repair with the bilateral mesh were seen at structured follow-up examinations 6 and 12 months postoperatively.
Conclusion
Treatment of bilateral inguinal hernias with the newly designed bilateral mesh for TAPP theoretically brings benefits in terms of resistance to forces acting on the mesh. The larger area may decrease the risk for mesh bulging and recurrence, and one large mesh might provide more stable support than two separate meshes overlapping at the midline. The results of our study do not confirm these theoretical benefits regarding a high recurrence rate (2.8%) after treatment of medial hernia defects. We recommend re-designing the mesh with only a small central slit, which would provide a broader mesh bridge with sufficient overlap for all types of inguinal and femoral hernias, including medial and supravesical defects. After the mesh has been re-designed, a new study should evaluate its real benefits before it is marketed.
References
Fitzgibbons RJ Jr, Forse RA (2015) Clinical practice. Groin hernias in adults. N Engl J Med 372:756–763
Pahwa HS, Kumar A, Agarwal P, Agarwal AA (2015) Current trends in laparoscopic groin hernia repair: a review. World J Clin Cases 3(9):789–792
McCormack K, Scott N, Go PM, Ross SJ, Grant A (2003) Collaboration the EU Hernia Trialists Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001785
Pfeffer F, Riediger H, Küfner Lein R, Hopt UT (2008) Repair of bilateral inguinal hernias—sequential or simultaneous? Zentralbl Chir 133(5):446–451 (article in German)
Wolloscheck T, Konerding MA (2009) Dimensions of the myopectineal orifice: a human cadaver study. Hernia 13(6):639–642
HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165
Stoppa R, Petit J, Abourachid H, Henry X, Duclaye C, Monchaux G, Hillebrant JP (1973) Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach. Chirurgie 99(2):119–123 (French)
Bury K, Smietanski M (2012) 5-year results of a randomized clinical trial comparing a polypropylene mesh with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty. Hernia 16(5):549–553
Currie A, Andrew H, Tonsi A, Hurley PR, Taribagil S (2012) Lightweight vs. heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis. Surg Endosc 26(8):2126–2133
Stechemesser B, Jacob DA, Schug-Paß C et al (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16(3):269–276
Köckerling F, Schug-Pass C (2014) What do we know about titanized polypropylene meshes? An evidence-based review of the literature. Hernia 18(4):445–457
Zhu LM, Schuster P, Klinge U (2015) Mesh implants: an overview of crucial mesh parameters. World J Gastrointest Surg 27(10):226 236 7(
Sardey HM1, Schopf S, Rudert W, Knappich P, Hernandez-Richter T (2004) Titanised polypropylene meshes: first clinical experience with the implantation in TAPP technique and the results of a survey in 22 German surgical departments [article in German]. Zentralbl Chir 129(5):363–368
Daes J, Felix E (2017) Critical view of the myopectineal orifice. Ann Surg 266:e1–e2
Bendavid R (1992) The space of Bogros and the deep inguinal venous circulation. Surg Gynecol Obstet 174(5):355–358
Köhler G, Mayer F, Lechner M, Bittner R (2015) Small bowel obstruction after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report and review of the literature. Hernia 19(3):389–394
Miserez M, Alexandre JH, Campanelli G et al (2007) The European hernia society groin hernia classification: simple and easy to remember. Hernia 11(2):113–116
Lee SR (2017) Clinical characteristics and laparoscopic treatment of supravesical hernia. J Laparoendosc Adv Surg Tech A 27(11):1192–1197
Antoniou SA, Köhler G, Antoniou GA, Muysoms FE, Pointner R, Granderath FA (2016) Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair. Am J Surg 211(1):239–249
Mayer F, Niebuhr H, Lechner M et al (2016) When is mesh fixation in TAPP-repair of primary inguinal hernia repair necessary? The register-based analysis of 11,230 cases. Surg Endosc 30(10):4363–4371
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
G. K. has received honorariums from Medtronic, Dahlhausen and Bard for lectures and educational activities. I. F. declares no conflict of interest. No competing financial interests exist. R. K. declares no conflict of interest. No competing financial interests exist. M. M. declares no conflict of interest. No competing financial interests exist. G. S. has received honorariums from Medtronic and AFS-Medical for lectures und educational activities outside this work. AFS is the company marketing the T02 mesh but the honorariums was not paid for suggesting changes in mesh configurations and mesh development. A. S. has received honorariums from Medtronic and AFS-Medical for lectures und educational activities outside this work. AFS is the company marketing the T02 mesh but the honorariums was not paid for suggesting changes in mesh configurations and mesh development.
Ethical approval
No ethical approval was required for this study.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent
All patients provided informed consent for treatment with the newly designed CE certified mesh and TAPP procedure.
Rights and permissions
About this article
Cite this article
Köhler, G., Fischer, I., Kaltenböck, R. et al. Critical evaluation of an innovative mesh for bilateral transabdominal preperitoneal (TAPP) repair of inguinal hernias. Hernia 22, 857–862 (2018). https://doi.org/10.1007/s10029-018-1786-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-018-1786-0