• Lukas Brügger, Martina Bloesch, Ramin Ipaktchi, Anita Kurmann, Daniel Candinas, and Guido Beldi.
• Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. lukas.bruegger@insel.ch
• Surg Endosc. 2012 Apr 1; 26 (4): 1079-85.

BackgroundIrritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed objectively. We objectively investigated hypoesthesia and chronic pain after transabdominal preperitoneal inguinal hernia repair (TAPP) with titanium spiral tacks (STs) compared with tissue adhesive (TA) for mesh fixation.MethodsMesh fixation in 80 TAPP procedures was randomized to fixation with ST (n = 40) or TA (n = 40). The outcome parameters included hypoesthesia assessed with von Frey monofilaments, early postoperative and chronic pain with the visual analog scale (VAS), morbidity (surgical-site infection, hematoma/seroma, relapse of hernia, trocar hernia), and recovery time to normal activity.ResultsMedian (range) follow-up was 38 (13-56) months. Demographic and baseline parameters were similar in the two groups. Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group (6 weeks: 32 vs. 6%; 6 months: 38 vs. 14%; 12 months: 34 vs. 13%; 13-56 months: 32 vs. 4%). Mean hypoesthesia scores over all time points were significantly higher in the ST group. The percentages of regions with hypoesthesia (abdominal, inguinal, or genitofemoral) following all procedures were higher in the ST group after 6 weeks (14 vs. 2%), 6 months (15 vs. 5%), and 13-56 months (22 vs. 4%). The intensity of pain decreased significantly in both groups over time.ConclusionsPostoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling.

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