الفهرس 
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Abstract
SUMMARY
L
aparoscopic hernia repair is more difficult technically than open surgery and there is evidence of learning curve in its performance and many complications which reported from laparoscopic procedure is due to learning curve lead to operative complications.
But also, laparoscopic approach has its benefits as rapid recovery, quicker return to work, less acute pain complication, better quality of life outcomes.
Many techniques were used for fixation of mesh and theories proved that there is no significant difference between each technique, and surgical options for mesh fixation include, but are not limited to, sutures, tacks or staples, self-fixing meshes and fibrin, or other glues.
The aim of our study is to compare the outcome results of the fixation of mesh by intracorporeal sutures and by tackers in TAPP hernia repair.
In our study, 30 patients were included divided on two groups, 15 for each. group A; fixation mesh with tackers, group B; fixation mesh with intracorporeal sutures.
Both groups were compared in terms of operative technique, operative time, mesh device fixation cost, intra & post operative complications, early post operative pain within two weeks and in first month, hospital stay, restriction of physical activity and incidence of recurrence and chronic pain.
Interpretation of results revealed comparable results between the two groups except in Intraoperative time which was significantly longer in group A (137.33 ± 11.47 min with the range (120 – 160) min) than group B (102.67 ± 16.68 min with the range of (80 – 140) min). The mesh fixation device cost shows also a significant difference between two groups as Tackers cost 7500 L.E but if we using sutures we can just cost 100 L.E or 200 L.E according to the number of package we use.
Based on our prospective randomized study, a few preliminary conclusions can be made.
We found that using Intracorporeal sutures for fixation mesh is available, cheaper and more handle than using the Tackers which are expensive and less available so it makes a laparoscopic hernia more practical and decrease need for open surgery so we avoid the complication of open surgery.
Both techniques are considered safe and effective with similar rates of recurrence and chronic pain although further wider scale studies are recommended.
CONCLUSION
TAPP hernia is considered safe as all perioperative complications are well tolerated by patients and mostly there was no need for a second operative intervention.
Both techniques of mesh fixation (sutures / tacks) are effective in the management of inguinal hernia and were associated with same recurrence rate. However, due to small sample size and short follow up duration, longer-term studies are also recommended.
Sutures are cheaper and usually available but with increased operation time and are technically more difficult , on the other hand Tacks are easy to use in mesh fixation but are expensive and may not be always available.