Difference between mesh fixation vs no fixation..

[drtowfigh]

Fixation can be associated with chronic pain. Sometimes it’s necessary but if it’s not necessary, then most of us prefer not to use it.

The mesh itself causes an inflammatory reaction that makes it “stick” in place. Also, in many situations where fixation is not necessary, the space is made perfectly to allow for the mesh to stay as it is placed.

[Good intentions]

“No fixation” is also associated with chronic pain. Apparently, there is no definitive evidence supporting either. Publication linked below. People should also be aware of the many different types of “fixation”. Sutures, absorbable tacks, titanium tacks, staples, glues, etc. Even the “no fixation” meshes, like Progrip, actually use a sort of fixation, it’s just already attached to the mesh.

The surgeon who implanted the mesh in me was very proud of his creation of the “perfect space”, so the mesh would not move. He described it to the friend-surgeon that recommended him. The mesh was out of place, it had dropped-migrated downward, and was folded on the direct hernia side, when it was removed three years later. The perfect space didn’t work.

Sorry Dr. Towfigh, but these are just the real-world things that happened to me. I had all of the boxes checked for a perfect result, the expereinced surgeon, the lightweight mesh, the TEP procedure, no fixation, etc. It wasn’t even close.

Also note how the authors of the paper below used “No evidence for fiaxtion” in the title but the actual work shows no evidence for either. I don’t think that they are actually trained in the scientific method. Their biases are evident. I don’t understand how it happens but it’s right there in the work they published. IT’s very disconcerting. The title should clearly state the matter is undecided.

<b data-test=”article-title” data-article-title=””>No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials

• K. A. Riemenschneider,
• H. Lund &
• H. C. Pommergaard

<b data-test=”article-title” data-article-title=””>

https://link.springer.com/article/10.1007/s00464-023-10237-0

link.springer.com

No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials - Surgical Endoscopy

Objective To investigate the differences in hernia recurrence and chronic postoperative inguinal pain (CPIP) in randomized, controlled trials comparing fixation and non-fixation of the mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Methods A multi-database systematic search was conducted … Continue reading

[Shinku]

Thanks so much for the reply! This eases my mind. I like my surgeon I’m just scared after I heard no fixation is used. So is 3D max contoured mesh a good choice for an inguinal hernia repair in an active male that does alot of exercise? I just wanna make the best decision for my well being. I’ve already consulted with two surgeons and they both recommended me the same exact operation which is a robotic repair with mesh.

[Good intentions]

Professional athletes generally avoid mesh. That is a reality.

Not really clear who you are, you sound familiar, but for anybody that comes across this thread – just read the posts from the beginning of the forum. Nothing has changed. Nothing has improved. You might think that “they must have solved these problems” but they have not. It’s all the same, just more of it. More laparoscopic methods and more mesh being used. I am not exaggerating. The same stories, the same inconclusive research studies. It is pretty amazing how consistent things have been. The paper I linked above is from 2023. Inconclusive, but the question about fixation is decades old.

Robotic surgery is just automated/remote TAPP surgery. General anesthesia with a transabdominal approach to the posterior wall. The same meshes and fixation methods are used. The odds of the results will be the same as a TAPP procedure.

I really do wish I could be more positive and deliver the good news that the forum was intended to deliver. But things have stayed the same over the years. The means to cause improvement seem to be developing but the pace of progress is glacial.

[drtowfigh]

The lighter the mesh weight, for inguinals, the more important is the fixation.

Heniford has paper publishing showing chronic pain rate is directly associated with amount of mechanical fixation (tacks). There are also many population based papers which show use of fixation increases risk of chronic pain. That doesn’t mean not using fixation prevents all chronic pain.

Let’s not confound surgeon and surgical technique with fixation vs not fixation. No amount of fixation will counteract a poorly placed mesh or a bad decision making by the surgeon.

Which is why I press that you should find a surgeon who you can trust and allow them to do their job.

[Shinku]

Ok , thank you!! About how long until the mesh usually starts to solidify in place without the use of fixation? or it never does?

[Oceanic]

2 weeks for the scar tissue to form and for it to set I think, the mesh can still fold or migrate years later though.

[Shinku]

Got it. So this is actually preferred over using a flat mesh with tacks and or sutures you’d say? Even for someone active ?

[Oceanic]

From what I gather some are self fixing but speak to a surgeon as advice on here can be sketchy, I’m not a medical professional just someone who’s had a hernia and learnt a bit on the way

[Oceanic]

The fixation technique can cause issues which is why its seen as a positive not to fix it as a suture or tack into a nerve will give you chronic ongoing pain