Investigating a possible cause of mesh migration during totally extraperitoneal (TEP) repair

Background: In experienced hands, laparoscopic inguinal hernia repair has a low rate of recurrence, but it still can recur, and a number of reasons for this have been identified. In published studies, the majority of such cases seem to result from inadequate dissection leading to missed hernias or suboptimal mesh placement. But even with adequate dissection and proper placement of a sufficiently large mesh, recurrence sometimes happens. A number of investigators have cited mesh migration or dislocation as a possible cause, and this study examined how hip flexion affects the position of newly placed meshes and staples in totally extraperitoneal (TEP) repair of inguinal hernia. Methods: After completion of the dissection and reduction of discovered hernias, a 15x15-cm polypropylene mesh was placed either unilaterally or bilaterally, as indicated. The preperitoneal space then was desufflated. The operating table, in an extended -20degrees position during surgery, was placed in a 90degrees position for approximately 15 s. After reinsufflation, the possibility of mesh migration and folding was investigated. Finally, the mesh was stapled, the table again extended and flexed, and the possibility of mesh migration and staple dislodgement investigated once more. Results: The mesh did not migrate or become displaced from any potential hernia area, nor did any of the staples become dislodged. Conclusions: Concern about mesh migration attributable to patients sitting up immediately after surgery appears to be unfounded, at least according to the findings for the current, small, simulated study group. patients who have undergone inguinal hernia repair begin ambulating almost immediately after surgery. When this repair was performed laparoscopically, some investigators have cited early displacement, folding, or invagination of the mesh during the immediate postoperative period [6, 9] as a possible cause of recurrence. This prospective study was planned to duplicate as closely as possible the stresses involved in chair sitting (hip flexion), and to determine their effects on newly placed mesh before and after stapled fixation. Desufflation of the pneumopreperitoneum also was evaluated for its effects on mesh folding and displacement.