Absorbable tacker fixation versus non-fixation in totally extraperitoneal inguinal hernia repair: a prospective randomized study on postoperative pain and quality of life

The role of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. While fixation may increase postoperative pain, concerns about recurrence in larger defects prevent its complete abandonment. This study aimed to compare absorbable tacker fixation with non-fixation in terms of postoperative pain, quality of life, and recurrence. In this prospective, randomized, controlled clinical trial, 60 patients undergoing primary unilateral TEP repair were allocated to either absorbable tacker fixation (n = 30) or non-fixation (n = 30). Primary endpoints included postoperative analgesic requirement, pain scores (VAS), and EuraHS quality of life (QoL) scores. Secondary endpoints were hematoma, seroma, and recurrence. Multivariable analysis was performed to evaluate factors affecting early postoperative pain. Baseline characteristics were comparable between groups. Early postoperative pain and analgesic requirements were significantly higher in the tacker group (analgesic doses: p = 0.001; VAS 8 h: p = 0.001; VAS 24 h: p = 0.002). Multivariable analysis confirmed tacker fixation as an independent factor associated with increased early pain (VAS 8 h: β = 1.20, p = 0.001; VAS 24 h: β = 0.95, p = 0.004). No significant differences were observed in long-term VAS or overall EuraHS QoL scores. Hematoma/seroma rates were not associated with tacker use. However, increasing defect size was significantly related to hematoma/seroma formation (p < 0.001), with defects 1.5–3 cm showing higher risk compared with < 1.5 cm (RR 9.55, p = 0.018). Recurrence occurred in one patient in the non-fixation group and was not statistically significant. Absorbable tacker fixation in TEP repair was associated with increased early postoperative pain, whereas long-term pain and quality-of-life outcomes were comparable between groups. Defect size was associated with postoperative hematoma/seroma occurrence; however, findings regarding infrequent outcomes, particularly recurrence, should be interpreted cautiously because of the limited sample size. These findings suggest that selective rather than routine fixation may be considered, although larger adequately powered studies are needed to confirm its long-term safety. ClinicalTrials.gov, NCT07605377. First submitted on 19 May 2026. Retrospectively registered.