Modern Perspectives on Inguinal Hernia Repair: A Narrative Review on Surgical Techniques, Mesh Selection and Fixation Strategies

Abstract

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods-including tacks, sutures, and glues-are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair.

Keywords: TAPP; TEP; inguinal hernia repair; mesh fixation methods; minimally invasive surgery; prosthetic mesh.

Figure 1

Port placement for unilateral left inguinal hernia repair. Modified from reference [43].

Figure 2

Illustration of the “five triangles” in right inguinal hernia. Modified from reference [34].

Figure 3

Port placement TEP procedure.

Figure 4

Shrinkage properties of meshes [63].