Mesh fixation with the helical fastener in laparoscopic herniorrhaphy: initial results.

In laparoscopic herniorrhaphy, an alternative to mesh fixation with a stapler is now offered by the helical fastener. The helical fastener was used in 46 patients (39 men and 7 women) with 30 unilateral and 15 bilateral inguinal hernias and 1 femoral hernia. We also used a 5-mm optical system, with which we were able to reduce the size of the trocar incisions. Two 5-mm incisions and one 7-mm incision were used. The fixation elements could easily penetrate bone; therefore, the mesh was easily fixed in the public bone. Laterally, the mesh was fixed in the iliopubic tract. The peritoneum was closed by continuous, extracorporeal knotted sutures. Complications included a wound hematoma in two cases and a small bowel obstruction secondary to inadequate closure of the peritoneum in another case. This was treated by the laparoscopic technique, and the peritoneum was closed with staples. All patients were available for follow-up after 6 to 12 months and were free of recurrence at that time. Patients started to stress the groin after 2 weeks (range 1 to 3). In view of the 40% reduction in incision size and the greater stability of mesh fixation, we prefer the helical fastener over stapler fixation.