Objective: Many studies have shown that non-fixation of mesh in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is safe and has no disadvantage compared to mesh fixation; however, most studies contain limited information on hernia-defect size. The purpose of this study was to compare the clinical outcome of non-fixation and fixation of mesh in consecutive elective laparoscopic TEP inguinal hernia repair in any type and size of hernia defect classified by the European Hernia Society (EHS) groin hernia classification to be a part of the level 1 evidence about technique of fixation in TEP.

Patients and Methods: One hundred and ten hernia repairs in 101 patients were enrolled in the trial between July 2022 and August 2023. The patients were randomized to the mesh fixation group (n = 55) or the non-fixation group (n = 55). The primary outcomes were chronic groin pain and recurrence at 6 months. The secondary outcomes were operative time, conversion rates, pain scores, analgesic requirement, time to regular activity, complications, and length of stay. A person blinded to the method of fixation performed statistical analysis.

Results: There were no significant differences between the two groups in baseline demographic charac-teristics, including age, BMI, sex, ASA classification, EHS hernia classification, and incidence of recurrent defect. More than 90% of hernia defects were larger than 1.5 cm, and more than 25% of defects were > 3 cm. They were statistically similar in both groups in terms of chronic groin pain, operative time, conversion rates, pain scores, analgesic requirement, time to regular activity, length of stay, and complications. Neither group had a recurrence at a minimum follow-up of 6 months.

Conclusions: There was no statistical significance in chronic groin pain and recurrence between fixation and non-fixation groups. The non-fixation approach should be adopted routinely and safely in laparoscopic TEP hernia repair. Even the tack fixation technique applied in this study was not associated with the risk of significant pain level and chronic groin pain; however, it is associated with high operative cost, so it should be used only in very selected situations in TEP.