Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair - A prospective randomized trial

Background: Controversy exists regarding whether it is necessary to secure the mesh prosthesis during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, or port-site hernia. Methods: We conducted a prospective randomized trial comparing stapled with nonstapled laparoscopic TAPP inguinal hernia repairs in a series of 502 consecutive patients undergoing elective inguinal hernia repair at two institutions between January 1995 and March 1997. Results: In all, 263 nonstapled and 273 stapled repairs were performed in 502 patients. Patients were evaluated at a median follow-up of 16 months (range, 1-32 months) by independent surgeons. There was no statistical difference in the incidence of recurrence (0 to 263 nonstapled, 3 to 273 stapled; chi-square p = 0.09). The overall recurrence rate was 0.6%. There was no significant difference in operative time, port-site hernia, chronic pain or neuralgia between the two groups. Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair, allowing a reduction in the size of the ports.