Suture Versus Tacker Mesh Fixation in Laparoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia: A Randomized Comparative Study

Abstract

Background: Mesh fixation is a technically important step in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Tackers permit rapid fixation but may increase tissue trauma, postoperative pain, device-related cost, and the risk of nerve irritation. Intracorporeal suture fixation avoids penetrating metallic implants but requires greater technical expertise and may prolong surgery. Evidence directly comparing these techniques remains heterogeneous, particularly in resource-constrained settings. Methods: This randomized comparative study included 60 adults undergoing elective laparoscopic TAPP repair for unilateral or bilateral primary inguinal hernia at a tertiary teaching hospital. Participants were allocated by a computer-generated sequence with sealed opaque envelopes to suture fixation (Group A, n=30) or tacker fixation (Group B, n=30). The primary outcomes were postoperative pain and hospital stay. Secondary outcomes included operative time, rescue analgesia, early complications, return to routine activity, neuralgia, and recurrence up to six months. Categorical variables were compared using the chi-square or Fisher exact test and continuous variables using the independent-samples t test. A two-sided p value <0.05 was considered statistically significant. Results: Baseline demographic, body mass index, American Society of Anesthesiologists status, hernia laterality, and intraoperative hernia type were comparable. Tacker fixation significantly shortened mean operative time for unilateral repairs (74.6±12.1 versus 92.4±14.8 minutes; p<0.001) and bilateral repairs (88.4±10.2 versus 108.6±12.5 minutes; p<0.001). At six hours, suture fixation was associated with a more favorable pain distribution (p=0.04); mild pain occurred in 40.0% versus 16.7%, while severe pain occurred in 6.7% versus 16.7%. At 24 hours, the difference was not statistically significant (p=0.10). Rescue analgesia was required by 30.0% of the suture group and 53.3% of the tacker group (p=0.07). Early complications, length of stay, return to activity, neuralgia, and recurrence did not differ significantly. At six months, recurrence occurred in 1/27 (3.7%) patients after suture fixation and 2/26 (7.7%) after tacker fixation (p=0.55). Conclusion: Tacker fixation offers a clear operative-time advantage, whereas suture fixation provides better immediate postoperative pain control without increasing complications, hospital stay, delayed recovery, or short-term recurrence. In settings where device cost and postoperative comfort are important, suture fixation is a reasonable alternative when laparoscopic suturing expertise is available.

Keywords: inguinal hernia; transabdominal preperitoneal repair; TAPP; mesh fixation; suture; tacker; postoperative pain; recurrence.