Posted by Hernia MD on July 29, 2009, 8:52 pm, in reply to "HerniaMD, what's the downside of titanium tack fixation?"
24.62.30.X
Tacks have been used in the lap repair because of the notion that mesh fixation is required to prevent recurrence. There is no evidenced based data to show that the use of tacks lowers the risk of recurrence in inguinal hernia surgery. There are several large series of lap inguinal hernia repairs without tack fixation with very low recurrence rates. I personally almost NEVER use tack fixation during inguinal hernia repair. IF the surgeon feels that tack fixation is required (despite the lack of data to support this) only short term fixation is required since all of the mesh products incorporate quickly into the healing tissue. Up until just about a year ago, titanium tacks were the only product on the market. There are now two acceptable absorbable tackers available (Covidien and Bard). I personally feel that THERE IS NO ROLE FOR THE USE OF PERMANENT TACK FIXATION IN THE LAPAROSCOPIC REPAIR OF GROIN HERNIAS IN 2009. I stand strongly behind this statement. Titanium tacks have been a problem for many patients in the past. Ask your surgeon to use one of the new absorbable tacks if he/she demands tack fixation. Otherwise, I would find another surgeon.
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