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Hernia mesh fixation questions
There is no standard. There are randomized controlled trials that have proven that a variety of techniques (tacks or no tacks, glue or no glue) are all adequate. I typically do not tack or glue. For larger hernias or in larger build patients, I tack, because the rate of mesh billowing into the hernia defect is much higher. With the robotic technique, I prefer to sew rather than tack, as it is a more elegant technique to fix the mesh. And I feel that there is less pain than tacking, but that has not been proven. I use titanium permanent tacks and permanent sutures. There is no proof that absorbable tacks are superior or cause less pain. They are just much more expensive. Regardless of the fixation or lack of fixation, mesh can move or fold.
Surgery is as much an art as it is a science. The technique should be tailored to the needs of the patient. A small hernia in a thin patient is treated differently by me than a large hernia in an obese patient. They cannot all be provided the same repair. And still, with the same repair performed on similar patients, two different outcomes may be expected. Each patient reacts to surgery, mesh, etc., differently. We don’t know enough to predict who will do best with which mesh or which technique.