الفهرس 
The pectineal ligamentOnly 14 pages are availabe for public view
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Abstract
Aim of the work: It was to compare mesh fixation versus non-fixation in lap TEP inguinal hernia repair regarding operative time, early postoperative pain, late postoperative pain, cost, complications and recurrence rate. Patients and Methods: This study was a prospective randomized comparative study that was carried out in the Gastrointestinal and Laparoscopic surgery Unit of Tanta University Hospitals from July 2017 to July 2018 on 40 patients with inguinal hernia underwent totally extra peritoneal inguinal hernia repair (TEP), our patients were randomized by Closed Envelop Method into 2 equal groups:- group A: A 12 x 15 cm polypropylene mesh rolled from lateral to medial and introduced through the 10 mm infraumbilical port and unfolded from medial to lateral. The mesh was fixed with tackers. (20 cases). - group B: : A 12 x 15 cm polypropylene mesh rolled from lateral to medial and introduced through the 10 mm infra umbilical port and unfolded from medial to lateral. The mesh was inserted without fixation. (20 cases). Results: The age mean ± SD of the mesh fixation group was 40.10 ± 12.39 years (range: 21-62 years) while that the age mean ± SD of the mesh non-fixation group was 41.60 ± 15.26 years (range: 20-72 years). All 40 cases in both groups of our study were unilateral hernias. Right-sided hernias were in 23 patients (57.5 %) and left-sided hernias in 17 patients (42.5%). Indirect hernias were more common than direct ones in both groups (82.5%), which were confirmed intraoperative by the lateral origin of the hernia to the inferior epigastric vessels. In mesh fixation group, indirect hernias were found
in 17 patients (85%) and direct hernias were found in 3 patients (15%) while in mesh non fixation group, indirect hernias were found in 16 patients (80%) and direct hernias in 4 patients (20%). Mesh fixation group had a longer time than mesh nonfixation group. In mesh fixation group, the minimum time was 45 minutes and the maximum time was 80 minutes with the mean operative time 64.0 ±9.95 minutes. In mesh nonfixation group, the minimum operating time was 40 minutes and the maximum time was 75 minutes with the mean operating time 56.0±10.59 minutes. The mean ± SD of pain according to VAPS of mesh fixation group was (1.25 ± 2.38) with 15 patients (75%) had no early postoperative pain, 3 patients (15%) had mild pain and 2 patients (10%) has moderate pain. In mesh nonfixation group the mean ± SD of pain was (0.90 ± 1.97) with16 patients (80%) had no pain, 2 patients (10%) had mild pain and 2 patients (10%) had moderate pain. In our study only 1 patient (5%) of both groups had accidental peritoneal tear that was managed by insertion of veress needle in the peritoneal cavity to work as a vent. No cases needed conversion to open hernia repair or TAPP procedure or bowel and visceral injury in our study. No cases were found in our study regarding vas deferens, spermatic vessels injury or iliac vessels injuries were found. No cases were found in both groups of intraoperative blood oozing, bleeding or inferior epigastric artery injury. We have used drain in 1 patient of each group. We had no cases had chronic groin pain in both groups for 6 months follow up. We had no cases of post-operative seroma or hematoma, one patient in each group (5% each) had scrotal edema. Postoperative surgical emphysema was present in 2 patients (10%) in each group. Regarding the hernia recurrence, no recurrences with mesh fixation group with 1 patient with recurrence in the postoperative visit 1 (after 1 week) who wasn’t admitted again at our unit. Regarding the hospital stay, in our study, the Mean ± SD of hospital stay in mesh fixation group was 1.35 ± 0.67 in comparison to 1.30 ± 0.66 in mesh non-fixation group. The Mean ± SD of the total cost of mesh fixation group was 4539.8 ± 2591.2 while in mesh non fixation group was 639.3 ± 16.24 which is statistically significant.