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Comparative Study
. 2025 Jul 11;29(1):229.
doi: 10.1007/s10029-025-03344-5.

Transabdominal pre-peritoneal hernia repair: risk of operation for recurrence depends on choice of both mesh and fixation device. A study from the Danish Hernia Database

Alexander Mortensen  1 , Anne Bodilsen  2 , Hans Friis-Andersen  3
Affiliations
Comparative Study

Transabdominal pre-peritoneal hernia repair: risk of operation for recurrence depends on choice of both mesh and fixation device. A study from the Danish Hernia Database

Alexander Mortensen et al. Hernia. .

Abstract

Purpose: Multiple methods of mesh fixation are available in laparoscopic inguinal hernia repair, as well as multiple types of mesh. No previous studies compare all methods of fixation in TAPP against each other in regards to risk of reoperation for recurrence. In addition, there is little data comparing types of mesh or the relationship between mesh and fixation method.

Methods: We compare the tissue-penetrating methods with non-penetrative as well as no fixation, and examines the interaction of fixation method and choice of mesh. Cohort was established by way of the Danish Hernia Database, identifying patients operated with TAPP from Jan. 2010 to Dec. 2022. Cox' regression analyses were performed, with multivariate analysis correcting for significant confounding variables, yielding adjusted hazard ratios (aHR) for reoperation for each fixation method. Follow-up analyses investigated whether differences in mesh types significantly impacted the results.

Results: Among 49,029 TAPP repairs, 3.6% experienced reoperation for recurrence over a mean follow-up of 5.76 years. Tack fixation, the most common method, showed the highest reoperation rates (5.3% at 5 years). Glue, self-fixating meshes, and no fixation, had significantly lower risk in comparison (aHRs of 0.25, 0.21, and 0.51, respectively). Even after correcting for weight and pore size, some mesh types significantly impacted risk, with aHRs spanning 0.28 - 1.

Conclusion: Non-penetrative fixation methods and no fixation are associated with lower reoperation rates compared to tissue-penetrative methods, with self-fixating meshes carrying the lowest risk. In addition, we found significant differences in aHR between types of mesh.

Keywords: Cohort study; Inguinal Hernia; Laparoscopic inguinal hernia repair; Mesh fixation; Risk of reoperation.

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Conflict of interest statement

Declarations. This study meets the requirements of the STROBE statement checklist. Conflicts of interest: We, the authors, declare that we have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow-chart of patient inclusion
Fig. 2
Fig. 2
Kaplan–Meier plot showing reoperations by fixation method
See this image and copyright information in PMC

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