COMPARISON OF ABSORBABLE TACKERS VERSUS UNIDIRECTIONAL BARBED ABSORBABLE SUTURES FOR CLOSING PERITONEAL FLAP IN TRANS ABDOMINAL PRE-PERITONEAL HERNIA REPAIRS: A RANDOMISED CONTROLLED TRIAL

A hernia is the abnormal protrusion of an organ or tissue through a defect in the surrounding wall, most commonly seen in the inguinal region. Inguinal herniorrhaphy is one of the most frequently performed operations by general surgeons. With the rise of minimally invasive surgery, laparoscopic hernia repair has become widely practiced and is considered the preferred approach for bilateral and recurrent inguinal hernias. The two main laparoscopic techniques are transabdominal preperitoneal repair described in 1992 and totally extraperitoneal repair described in 1993. The TAPP procedure is easier to learn but requires entry into the peritoneal cavity, making mesh fixation and peritoneal closure a technical challenge.

Various methods exist for peritoneal closure in TAPP including tackers, staples, fibrin glue, and sutures. The choice depends on surgeon skill, institutional practices, postoperative pain outcomes, and cost. Tackers may increase cost and cause persistent groin pain, fibrin glue is painless but expensive, and sutures are cost effective but require advanced laparoscopic skills and increase operative time. The introduction of 3D 4K imaging has improved laparoscopic suturing, reducing operating time and enhancing depth perception.

TAPP repair performed by experienced surgeons is safe with recurrence rates similar to open surgery. Complication rates range between 2.5 and 27 percent, with common issues including postoperative pain, seroma, and recurrence, and rare cases of bowel obstruction. Peritoneal closure remains a key step since tackers can cause adhesions and suture knots may fail leading to herniation.

This study aims to compare two peritoneal closure techniques in TAPP repair focusing on postoperative pain, operative duration, and long term complications.