Clinical Consensus on the Role of Self‐Fixating Mesh in Laparoscopic Inguinal Hernia Repair

ABSTRACT

Introduction

The global burden of inguinal hernia (IH) has significantly increased. Mesh with self‐fixating technology helps provide superior tissue integration, reducing the need for additional fixation compared to conventional mesh. Benefits include shorter operative time, reduced hospital stay, lower recurrence rates, and improved quality of life. However, variability remains in its adoption and application. To address this, a panel of Asian hernia experts convened to develop a consensus and formulate recommendations on self‐fixating mesh (SFM) use in IH repair.

Method

A panel of 13 hernia experts participated in the consensus discussion and manuscript development. A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant articles and formulate statements. Consensus was assessed using a modified three‐step Delphi method, with an acceptance level of > 80%.

Results

In phase 1 of consensus development, 11 statements were reviewed, with 9 reaching consensus and 1 facing disagreement. Five additional statements were introduced based on expert input. Phase 2 reviewed all 16 statements, with one failing to reach consensus. In phase 3, an online reassessment of the revised version of the failed statement in the previous round was conducted via Microsoft Forms, leading to consensus on all 16 statements.

Conclusion

SFM offers significant advantages over conventional sutured meshes in IH repair. However, further research and multicenter trials are recommended to refine surgical protocols. Based on expert recommendations, SFM may be preferred in IH repair, and structured training can enhance its adoption, improving patient outcomes.

1. Introduction

The global burden of inguinal, femoral, and abdominal hernias has seen a significant rise, with approximately 32.53 million cases reported in 2019, marking a 36% increase since 1990 [1]. In Asia, particularly South Asia, the prevalence is notably high, with 3.10 million new and 8.85 million total cases [1].

Surgeons use meshes to strengthen the hernia repair and reduce recurrence. Lichtenstein repair for inguinal hernia (IH) (first described in 1989) is a widely accepted surgical method, with safety, effectiveness, and a lower recurrence rate [2, 3]. Study shows that Lichtenstein repair using mesh is associated with a significantly higher mean pain score, compared to laparoscopic repair using mesh in IH (p < 0.001) [4].

Tackers were introduced for mesh fixation in laparoscopic inguinal and ventral hernia repair during the 1980s and 1990s, respectively [5]. The pain involved and the permanent presence of titanium tacks in the body raised concerns about their long‐term safety [5]. To minimize complications from sutures and tackers in mesh fixation, glue‐based methods like cyanoacrylate and fibrin glue emerged [3].

The Self‐Gripping mesh, made of polypropylene monofilaments, with grips made of polylactic acid (PLA) was developed in 2006 [6]. The PLA grips degrade after 3–4.5 years of implantation [6]. The mesh has been indicated for inguinal and incisional hernia repairs [7]. Later in 2012, a mesh specific to laparoscopic groin hernia repair—the laparoscopic self‐fixating mesh (SFM) was produced. The mesh is made up of knitted monofilament polyester and PLA grips on one side, and fast‐resorbing collagen film on the other side, which allows better handling and deployment [6].

SFM is associated with lower pain [8], a low occurrence of chronic postoperative inguinal pain [9], and recurrence [8, 9]. Even with multiple benefits, there remains a significant variability in the adoption and application of SFM across different clinical settings, despite its wide use and application. A panel of Asian surgeons, experts in the repair of hernia, gathered to discuss the IH repair trends and to develop consensus as well as formulate recommendations on the use of SFM in IH repair in the region.

2. Methods

2.1. Selection of Panel

A panel of 13 expert surgeons from India, Singapore, Korea, Vietnam, Malaysia, and Thailand participated in the consensus rounds and contributed to the development of the manuscript. All experts, on average, had 15 years of expertise in inguinal hernia surgery and related clinical practice. The experts also had more than 10 publications and were eminent speakers for multiple international and national conferences.

2.2. Evidence Review

A comprehensive literature review was performed between September 2024 and October 2024 using the PubMed, Embase, and Google Scholar databases to identify relevant articles published. The search was done using keywords including “inguinal hernia,” “groin hernia,” “femoral hernia,” “self‐fixating mesh,” “self‐grip mesh,” “self‐gripping mesh,” “self‐adhesive mesh,” “laparoscopic surgery,” “minimally invasive surgery,” “laparoscopic repair,” “laparoscopy,” “TAPP hernia repair,” “TEP hernia repair” “sutureless repair” “open hernia repair,” “tackers,” “suture,” “staples,” “pain,” “acute pain” “chronic pain” “chronic postoperative pain,” “hernia recurrence,” “recurrence rate,” “hernia recurrence prevention,” “mesh fixation,” “mesh migration,” “mesh complications,” “postoperative outcomes,” “surgical time,” “Hernia guidelines,” “operative time,” “cost‐effectiveness,” “prophylactic antibiotics,” and “seroma,” were used. From the retrieved 183 articles, 41 full‐text studies were used for the study (Figure 1).

FIGURE 1.

Flow diagram of study selection process (PRISMA).

2.3. Delphi Survey Method Process and Administration

A modified 3‐step Delphi method was adopted to assess consensus for the proposed statements [10]. All members of the expert panel participated in the survey. The level of consensus was categorized as high (≥ 80%), moderate (60%–80%), and low (< 60%) (Figure 2) [11]. A minimum of 80% consensus level was to be achieved for statement acceptance. Recommendations were graded based on the quality of evidence as per GRADE (Figure 3) [12].

FIGURE 2.

Level of consensus and definition.

FIGURE 3.

Level of evidence and strength of recommendation. RCT, randomized controlled trial.

3. Results

Phase 1 of consensus development included discussions of clinical evidence for the 11 statements, developed after a literature review. Nine statements received consensus, and one statement met with disagreement. Five more statements were added based on expert suggestions. Phase 2 of the survey was conducted to review the new statements. A total of 16 statements (including statements agreed upon during the first round) were discussed, and all others except one statement did not meet consensus. Phase 3 of the survey was conducted online, and the 1 statement that did not meet consensus was reworded for better clarity by the panelists. An online questionnaire (via Microsoft Forms) was sent to the experts with the final statements, where all 16 statements met with the consensus (Figure 4).

FIGURE 4.

Statements and consensus (%). IH, inguinal hernia; SFM, self‐fixating mesh.

4. Discussion

4.1. Indications of Use

4.1.1. SFM Is Recommended for Primary IHs, Particularly in Patients Who Prefer Minimally Invasive Surgery Without Tackers or Minimum Use of Tackers

SFM is a safe option for laparoscopic repair of primary inguinal hernia [13, 14]. A retrospective study by Birk et al. reported that the laparoscopic fixation of SFM in 220 primary hernias resulted in 95.9% satisfaction with the hernia repair. The study showed only 3 reports of recurrence, 1.2% severe pain, and 3.6% reported mild pain. The study demonstrated that SFM is rapid, efficient, and safe [13]. Another trial, which involved 68 unilateral and 60 bilateral primary IH, reported rapid pain relief and return to normal activities in approximately 16 days, with overall quality of life improvements after 3 months. Laparoscopic transabdominal preperitoneal repair (TAPP) and total extraperitoneal repair (TEP) techniques were performed for IH surgery [14].

A Herniamed registry‐based study including 241 patients (396 hernias) and a follow‐up period of 12 months reports that the use of SFM with the TAPP technique is fast, effective, and reliable, and reduces post‐operative pain [with 2 people (0.97%) reporting 4–6 VAS score]. No recurrence rate was reported in the study, and no chronic pain was reported. The study concludes that in individuals with IH undergoing surgery under the care of experienced surgeons, SFM is beneficial [15]. SFM also has superior grip strength (3.2 N/cm²) compared to other fixation techniques [hernia stapler (2.7 N/cm²), fibrin glue (0.9 N/cm²), or unfixed mesh (1.5 N/cm²)] according to pre‐clinical studies [16], making SFM an ideal option in laparoscopic surgery, and for patients who want a tacker‐free and minimally invasive treatment option for their IH management.

Experts' opinion/consensus recommendation: SFM can be effective and safe and may be recommended for people with primary IHs who prefer minimally invasive surgery. The experts agreed on the statement with 93% high agreement.

4.1.2. SFM Can Be Used for Laparoscopic Hernia After Previous Open Anterior Repair(s)

The repair of recurrent IH post‐prosthetic mesh repair is complex. Patients who undergo laparoscopic surgery recover faster and have reduced recurrence compared to open repair [17]. A randomized controlled trial (RCT) involving 997 patients with IH reported that laparoscopic repair is associated with fewer recurrences and chronic pain compared to conventional open anterior repair [18]. The International Guideline on groin hernia management suggests that the laparoscopic posterior approach is preferred for recurrences after anterior repair [19].

Experts' opinion/consensus recommendation: Laparoscopic mesh repair can be preferred for treating the recurrence of hernia after an open repair. The experts agreed on the statement with 100% high agreement.

4.1.3. SFM Can Be Used for an Open Repair After a Previous Laparoscopic Posterior Repair

Minimally invasive laparoscopic techniques have been shown to have reduced surgical site infections and chronic pain [20]. However, the use of SFM in open repair is simple, rapid, effective, safe, reduces postoperative pain, recurrence, and improves QOL [21].

An RCT among 270 patients who underwent open repair with SFM reported that only 1% of patients had recurrence [21]. Another RCT also reports that patients with recurrence after a laparoscopic repair must undergo an open mesh repair. Also, the laparoscopic operation of a recurrent IH after laparoscopic repair showed no significant advantage compared with open repairs [22].

Experts' opinion/consensus recommendation: SFM is safe and efficient in open hernia repair and can be used for treating recurrent hernia after a laparoscopic repair. The experts agreed on the statement with 100% high agreement.

4.1.4. Use of SFM Can Be Recommended After Both Previous Open and Laparoscopic IH Repairs

Studies have shown that SFM is effective in preventing and reducing recurrence in laparoscopic repair [23] and open repair [21, 22] of IH. A prospective multicentre clinical study was conducted among 189 patients (5% had recurrent IHs). Post‐open repair surgery, the SFM group was reported to have no recurrence, only 4.5% complications, significantly lower pain scores after 3‐month follow‐up (p < 0.0001), and improved QOL (p < 0.0001) [24]. SFM prevents further recurrence in patients who underwent open repair for a recurrent hernia.

Experts' opinion/consensus recommendation: For people with previous multiple recurrences, a tailored approach is necessary. Decision‐making involving the patient, surgeon, and doctor is also recommended. The experts agreed on the statement with 93% high agreement.

4.2. Intraoperative Handling and Placement of SFM

4.2.1. Surgeons May Follow the Instructions for Use on SFM Placement and Handling Provided by the Manufacturer

SFM comes with an instruction for use (IFU) for its appropriate use and handling (Figures 5, 6, 7) [25]. The previously published pre‐clinical animal study shows that the placement of SFM, following the manufacturer's instructions, provided adequate strength and stability [26].

FIGURE 5.

Use and handling: ProGrip Self‐Gripping Polyester mesh (anatomical). (a) The choice of the mesh size is determined by the surgeon. This mesh can be used whole or cut to the required dimensions; (b) the mesh should be presented, slit upward, flap open, colored yarn (blue) marker toward the pubis, grip side facing the deep muscular plane; (c) fit the slit around the cord; (d) fold the flap back onto the mesh. Gripping is reversible to allow slit closure to be adjusted several times; (e) spread out the large curve of the mesh so that it perfectly fits the inguinal ligament; (f) completely spread the mesh, by positioning the cord in the central orifice to cover all weak areas completely.

FIGURE 6.

Use and handling: ProGrip Self‐Gripping Polyester mesh. (a) The surgeon determines the choice of the mesh size; (b) the surgeon should ensure necessary overlap of the mesh beyond the margins of the defect according to practice. When possible, a minimum of 5 cm overlap over the edges of the defect is recommended for incisional hernia repair; (c) the mesh can be used whole or cut to the required dimensions; (d) in case of IH repair, the mesh can be fixed to the Cooper's ligament and/or to the anterior muscular plane. Fixation can also be used between the posterior muscular plane and the anterior aponeurotic one (external oblique muscle); (e) spread the mesh evenly.

FIGURE 7.

Use and handling: ProGrip Laparoscopic Self‐Fixating mesh. (a) Hydrate the mesh; (b) with the grips facing down, fold the inferior flap up along the seam in the mesh; (c) fold the superior edge down over the edge created by the initial fold; (d) fold the mesh in half along the axis. To facilitate later deployment, do not roll or press the layers of the mesh together more than necessary; (e) grasp the mesh at either end and insert it through the trocar. It is recommended to use a trocar of at least 10 mm internal diameter to introduce a mesh of size up to 15 × 10 cm and a trocar of at least 12 mm internal diameter to introduce a mesh size 16 × 12 cm or above. Mesh insertion capability may vary depending on rolled mesh size and graspers/trocars used. Do not force the mesh through the trocar. Inappropriate insertion may lead to textile and/or film damage; (f) the midline placement may be easier to orient relative to the anatomy. Deploy the mesh and place the green band toward the pubic zone and the grips up in the preperitoneal space. Visually confirm sufficient medial overlap over Cooper's ligament and adjust the position of the mesh as needed. Use a blunt tip grasper, gently press the mesh into the tissue by starting medially and working laterally. First, unfold the top edge of the mesh, then the bottom edge, and gently press it against the tissue; (g) the placement of the mesh should assure necessary overlap beyond the margins of the defect. If necessary, reposition the mesh by peeling the mesh from the tissue rather than dragging it. Once comfortable with the placement, use a blunt tip instrument to press the mesh against the tissue.

Experts' opinion/consensus recommendation: Following the manufacturer's instructions is helpful in SFM placement and handling. However, a doctor's/surgeon's opinion based on the hernia defect is also necessary. The experts agreed on the statement with 100% high agreement.

4.2.2. Increased Experience and Familiarity With the Technical Nuances Reduce the Mesh Insertion and Placement Time With SFM

In a study by Mellert et al., 40 hernias were repaired in 29 patients with a laparoscopic TAPP approach by a single surgeon. While the first 20 surgeries took 249.4 s (mesh introduction to the final position), the next 20 surgeries had a significantly reduced time of 118.6 s (p < 0.001). No major complications were also reported among the study population, and the average pain score was 0.9, which is low on a scale of 0 to 5 [27]. The study shows that an experienced laparoscopic surgeon can be proficient in handling self‐fixating mesh after 15–20 surgeries [27].

Surgeries performed by a surgeon with > 20 years of experience in laparoscopy among people with IH, the SFM group had significantly shorter mean operation time compared to the staple fixation group (p = 0.033) and lower pain [28]. Another RCT reported that laparoscopic IH surgeries performed by surgeons with experience of performing > 50 surgeries using SFM in patients reported lower pain and operative time, upon follow‐up after 6 months [29].

Experts' opinion/consensus recommendation: An experienced surgeon is necessary to improve surgical accuracy and outcomes. The experts agreed on the statement with 100% high agreement.

4.3. Postoperative Complication

4.3.1. Use of SFM Results in Low Incidence of Postoperative Pain Compared to Penetrating Fixation

Traditional meshes in hernia repair cause complications such as nerve damage and inflammation, causing pain and related adverse effects [30]. An Indian study conducted among 60 patients (1‐year follow‐up) reported that SFM had a lower postoperative pain score (p < 0.001) compared to traditional mesh [30].

Another study with 241 patients reported only 2 cases (0.97%) with moderate degree postoperative groin pain lasting for 12 months, and no cases of chronic pain of severe degree with the use of SFM [15]. Another Indian study conducted among 40 patients reported that the mean postoperative pain score after 3 days of IH surgery decreased by 68.52%, and after 3 months it decreased to 88.89% with SFM [31].

Experts' opinion/consensus recommendation: SFM is associated with lower postoperative pain compared to sutured mesh. The experts agreed on the statement with 92% agreement.

4.3.2. Use of SFM Results in Low Incidence of Chronic Pain as It Reduces the Need for Penetrating Fixation

A systematic review reported that SFM is associated with lower chronic pain, compared to conventional mesh fixation (p = 0.03) [32]. A retrospective study conducted among 211 patients reported that the incidence of chronic pain was very low (< 3%) after 3 years, with the use of SFM in laparoscopic IH repair [33]. A prospective RCT reported no chronic pain in the SFM group after 1 year of follow‐up [34]. Similar benefits have also been reported with SFM in another RCT [35].

Experts' opinion/consensus recommendation: Based on the available evidence and clinical experience, experts suggested that SFM may help reduce postoperative chronic pain in IH patients, compared to sutured/conventional meshes. The experts agreed on the statement with 100% agreement.

4.3.3. During Open Repair With SFM, With Increasing Hernia Defect Size, Other Forms of Fixation Are Suggested

Minimally invasive surgical techniques, such as laparoscopy, are safe and cost‐effective for large hernia defects [36]. A retrospective cohort study reported that the use of SFM without additional fixation, among a population with 46% large hernias (> 10 cm), 82% reported no pain and zero recurrence [37].

In a similar study with 7.25% large defect IHs, no site infections or early recurrences were reported among the study population, with SFM use [36]. However, a systematic review highlights that tacks, sutures, and fibrin glue in primary ventral or incisional hernia repair showed similar overall benefits [38].

Experts' opinion/consensus recommendation: Surgeons should decide on the mesh fixation technique that has to be used for large hernia repairs. For larger hernia defects, mesh fixation can be done, and for smaller defects (e.g., < 1 cm) or in conditions where hernia size is not defined, mesh fixation need not be done. The experts agreed on the statement with 92% high agreement.

4.3.4. There Is No Difference in Recurrence Rate Observed With Use of SFM Versus Non‐SFM

Studies show that IH repair with SFM was associated with no recurrence among the study population [23, 37]. An RCT conducted among 169 patients reported that only 3 people reported recurrence over a mean follow‐up period of 22.8 months [39]. Contrary to these observations, meta‐analysis studies (of LoE 2a) report that there is no significant difference in recurrence rates between SFM and conventional mesh [32].

Experts' opinion/consensus recommendation: Meta‐analysis reports that there are no significant differences in recurrence rate. The experts agreed on the statement with 85% high agreement.

4.3.5. Use of SFM Can Reduce the Risk of Vascular and Nerve Injury in Endo‐Laparoscopic Hernia Surgery Compared to Penetrating Fixation

SFM is effective in preserving nerves and reducing chronic pain [40]. The dissolvable micro‐grips for attachment provide a gentler fixation method that reduces trauma and neuropathic pain [41]. Such fixation is helpful in the inguinal region, where nerves and vessels are closely located at the surgical site [42].

A multicentre RCT reported lower pain in the SFM group [discharge (−10%) and at 7 days (−13%)], compared to the sutured mesh group [discharge (+39%) and at 7 days (+21%)]. The study concludes that this may be due to the reduced trauma to the surrounding tissues and nerves during the fixation procedure of SFM [42].

Experts' opinion/consensus recommendation: SFM has been reported to have reduced the risk of vascular and nerve injuries compared to traditional/sutured meshes. The panel agreed on the statement with 92% high evidence.

4.3.6. SFM Without Fixation in Large M3 Defects Is Not Recommended Because It Leads to a Higher Incidence of Meshoma

Meshoma is prevalent in groin hernia patients post‐Lichtenstein hernia repair, with a cohort study reporting the prevalence of meshoma in 31% of the study population (n = 74) [43]. Meshoma can be caused by mesh displacement due to non‐fixation, insufficient fixation, or inadequate dissection to create enough room for the prosthesis [44]. However, SFM has a reported lower displacement rate compared to other meshes [45]. The need for tacks for better fixation in SFM is a topic of discussion.

Experts' opinion/consensus recommendation: SFM with tackers may prevent meshoma formation. The use of tackers for hernia repair using SFM will depend on patient compliance, the doctors' choice of surgery, and the complexity of the surgery. More studies are required to conclude that the use of tackers, along with the lower displacement of SFM, can help prevent the incidence of meshoma. The panel agreed on the statement with 100% high evidence.

4.3.7. The Use of SFM With Fixation in Large Defects Is Associated With a Decrease in Mesh Migration and Recurrence Compared to SFM Without Fixation in Open Hernia Repair

Studies have shown that SFM is beneficial in large hernia repairs [36, 38]. Proper technique of SFM placement helps reduce mesh migration in large hernias [26]. However, reinforcement of the mesh using prosthetics has been the gold standard [46]. The use of tackers in SFM could depend on the complexity of the surgery and patient‐specific factors [45]. There is a lack of research on the use of tackers in SFM.

Experts' opinion/consensus recommendation: SFM with the use of tackers may help reduce the rate of displacement compared to SFM without tackers. Yet, more research is needed on the same. The panel agreed on the statement with 100% high evidence.

4.4. Postoperative Care

4.4.1. Postoperative Activity Restrictions Should Focus on Avoiding Heavy Lifting for 2–3 Weeks Rather Than Imposing a Complete Ban on Physical Activity. This Recommendation Applies to SFM as Well

The duration of hospital stays and early mobilization are essential for the patient during the postoperative course [47]. The advice given by the surgeon has an impact on patient compliance. The optimal time for patients to resume regular physical activity or lift weights following abdominal or hernia surgery is still up for dispute [47].

The European Hernia Society guidelines on the treatment of IH in adult patients recommend that postoperative activity restrictions should focus on avoiding heavy lifting for 2–3 weeks, rather than imposing a complete ban on physical activity [48].

From a survey conducted among 127 experts, the majority agreed that a 2‐week period of avoiding physical strain was appropriate post‐surgery. For open hernia repair, experts considered 4 weeks without physical strain to be suitable [47].

Experts' opinion/consensus recommendation: Available evidence suggests that restricting physical activity for 2–3 weeks can be ideal, rather than imposing a complete ban on physical activity. The experts agreed on the statement with 100% high agreement.

4.5. Training and Education

4.5.1. Using SFM Has Longer Learning Curve Even for an Experienced Laparoscopic Surgeon

Laparoscopic surgery performed by experienced surgeons using SFM has been reported to be rapid and efficient, with lower complications [39]. The study by Mellert et al. observed that surgeons with 15–20 laparoscopic IH surgeries can expect to become proficient in the placing and handling of SFM, indicating the learning curve that is demanded for the procedure [27]. Proper patient selection and thorough training can help reduce the risk of rare but serious complications during the learning curve of endoscopic techniques [48].

Experts' opinion/consensus recommendation: The experience of surgeons is important in hernia surgery. The absence of a structured training program, a standardized technique for surgery, and a learning curve is an area yet to be explored. The panel agreed on the statement with 92% high evidence.

4.5.2. Structured Training Program Should Be Planned for SFM Handling and Development of Standardized Technique

Although studies and guidelines have reported the benefits, a unified protocol for training and handling SFM has not been developed. The International Endohernia Society (IEHS) Part III guideline states that structured laparoscopic training has been shown to improve operator proficiency and operative performance of surgeons [49].

Another systematic review has shown that structured training programs help reduce perioperative complication rates for patients operated on by trainees [50]. In departments performing incisional/ventral hernia repair, a structured laparoscopic training program should be introduced (evidence grade A) [49].

Structured training programs in mesh handling at hospital department levels could improve surgical quality and hernia fixation.

Experts' opinion/consensus recommendation: A universal structured training on SFM handling is necessary. There is also a need to develop a standardized technique. The panel agreed on the statement with 100% high evidence.

5. Conclusion

With several benefits over conventional sutured meshes, SFM is a major improvement in IH fixation. Multiple meta‐analyses and guidelines recommend the use of SFM in IH repair.

SFM helps reduce postoperative and chronic pain, shortens operative time, and decreases hospital stays without raising the risk of complications like recurrence or seroma formation. Its sutureless fixation technique reduces tissue damage, which lowers the possibility of vascular and nerve damage. The decrease in postoperative pain and faster recovery make SFM a desirable alternative, especially for minimally invasive procedures. Customized patient care and surgeon experience are also important in maximizing results.

Despite the advantages of SFM, there are still challenges, such as the requirement for specialized training to get beyond the learning curve and standardize mesh‐handling methods. There is a lack of comprehensive and high‐quality data on SFM use among the IH population. Further research and multicenter clinical trials are recommended so that the research will benefit in refining surgical protocols and ensuring that the potential of SFM is explored across diverse populations. However, considering its multiple benefits and based on the expert group recommendations, SFM may be preferred in IH repair. With structured training and practice, the adoption of SFM can enhance the quality of care and outcomes in IH management.

Author Contributions

Study conception and design: Sujith Wijerathne, Shashank Rastogi. Data curation: Sujith Wijerathne, Shashank Rastogi. Acquisition of data: Sujith Wijerathne, Shashank Rastogi, KyungWon Seo, Junbeom Park, Mukund Thakur, Marc Ong Weijie, Tuan Le Quan Anh, Duong Trong Hien, Dato' Nik Ritza Kosai Nik Mahmood, Lau Peng Choong, Siripong Cheewatanakornkul, Pichest Watanapairojrat, Kreangsak Chainapapong. Analysis and interpretation of data: Sujith Wijerathne, Shashank Rastogi, KyungWon Seo, Junbeom Park, Mukund Thakur, Marc Ong Weijie, Tuan Le Quan Anh, Duong Trong Hien, Dato' Nik Ritza Kosai Nik Mahmood, Lau Peng Choong, Siripong Cheewatanakornkul, Pichest Watanapairojrat, Kreangsak Chainapapong. Drafting of manuscript: Sujith Wijerathne, Shashank Rastogi. Critical revision of manuscript: Sujith Wijerathne, Shashank Rastogi, KyungWon Seo, Junbeom Park, Mukund Thakur, Marc Ong Weijie, Tuan Le Quan Anh, Duong Trong Hien, Dato' Nik Ritza Kosai Nik Mahmood, Lau Peng Choong, Siripong Cheewatanakornkul, Pichest Watanapairojrat, Kreangsak Chainapapong.

Funding

The advisory board and the publication fees were supported by Medtronic.

Ethics Statement

For this article, no patients or animals were involved.

Conflicts of Interest

The advisory board was supported and funded by Medtronic. The sponsor had no role in data collection, data interpretation, or manuscript preparation.

Wijerathne S., Rastogi S., Seo K., et al., “Clinical Consensus on the Role of Self‐Fixating Mesh in Laparoscopic Inguinal Hernia Repair,” Asian Journal of Endoscopic Surgery 19, no. 1 (2026): e70255, 10.1111/ases.70255.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.