A prospective randomized control trial comparing intracorporeal sutures and tackers for mesh fixation in laparoscopic ventral hernias repair: intraoperative considerations

Background: Laparoscopic ventral hernia repair (LVHR) has covered a long distance since its first reported case in 1993. It is an established procedure, but the mesh fixation technique is a contested area. There is a paucity of literature comparing intracorporeal suturing with tackers for mesh fixation. Objectives: This study was done to check the feasibility of intracorporeal suture mesh fixation by comparing its intraoperative dynamics with tacker fixation. Patients and methods: 43 patients with defect size less than 8 cm were considered. They were randomized into two groups: group I, intracorporeal suture fixation, and group II, tacker fixation. Randomization was ascertained by assigning computer-generated random numbers using the technique of block randomization. Further, sealed envelopes were used for concealed allocation. Intraoperative variables were recorded and analyzed for 40 patients (20 in each group) as 3 were excluded from the study due to non-progression of dissection due to dense adhesions. Results: Operative mesh fixation time (49.4 ± 7.83 min versus 17.2 ± 2.86 min, p <0.0001) was found much lesser in group II. Total operative time was found to be significantly higher in group I (113.6 ± 0.91 min versus 88.35 ± 8.27 min, p <0.0001). Average blood loss was less in group I compared to group II (30.25 ± 8.95 ml versus 37.75 ± 11.41 ml, p =0.026). Conclusion: Intracorporeal suturing is a viable alternative for mesh fixation in LVHRs. Though intracorporeal suturing is associated with longer operative times, patients have less intraoperative blood losses statistically significantly.