Randomized clinical trial of fixation vs nonfixation of mesh in total extraperitoneal inguinal hernioplasty

Hypothesis: Mesh fixation in the extraperitoneal space during endoscopic total extraperitoneal inguinal hemioplasty might be related to an increase in postoperative pain, morbidity rate, and hospital costs. Design: Randomized clinical trial. Setting: University teaching hospital. Patients: From January 1999 to December 2001, 170 patients with inguinal hernia were invited to participate; 85 patients were randomized to each group. Intervention: Total extraperitoneal inguinal hemioplasty with or without mesh fixation using staples. Main Outcome Measures: Operating time, morbidity rate, chronic pain, recurrences, and hospital cost were analyzed. Follow-up was considered complete when it included a physical examination at 24 months (mean, 36 12 months). Results: The statistical study showed no significant differences with regard to epidemiological factors, hernia type, operating time, morbidity, or recurrences when the mesh was stapled, although the total cost of the process was higher (P<.001). Conclusions: Stapling the mesh in total extraperitoneal inguinal hemioplasty offers no advantages and increases the cost of the process. Our results suggest the possibility of limiting the use of mesh fixation in total extraperitoneal inguinal hemioplasty to cases of direct bilateral hernias.