Tacking is a surgical technique where small fasteners, similar to tiny staples, are fired into tissue to hold a piece of mesh in place during hernia repair or other procedures. It is most commonly used in minimally invasive (laparoscopic) surgery, where surgeons cannot stitch by hand as easily as they can during open operations. The tacks penetrate through the mesh and into the underlying tissue, anchoring the repair so it stays secure as the body heals.
How Surgical Tacking Works
During a laparoscopic hernia repair, a surgeon places a sheet of synthetic mesh over the weakened area of the abdominal wall. To keep that mesh from shifting, they use a specialized tacking device that fires small fasteners through the mesh and into the surrounding tissue. Each tack acts like a tiny corkscrew or helical staple, gripping muscle or connective tissue to lock the mesh in position. The surgeon typically places several tacks around the perimeter of the mesh to distribute the holding force.
Tacking is fast and straightforward, which is one reason it became the standard fixation method for laparoscopic hernia repairs. Robotic-assisted surgeries, by contrast, often skip tacks entirely. The robotic instruments give surgeons enough precision and dexterity to suture the mesh directly to tissue, avoiding mechanical fasteners altogether.
Types of Tacks
Surgical tacks come in two broad categories: permanent and absorbable. Permanent tacks are made from titanium. They stay in the body indefinitely and provide long-lasting fixation. Absorbable tacks are made from polymers that the body gradually breaks down over months, eventually dissolving completely.
Absorbable tacks were developed partly to reduce pain. Because they don’t penetrate as deeply into bone and other hard structures, they tend to cause less discomfort in the days and weeks after surgery. By the time the body has healed enough to hold the mesh on its own, the absorbable tacks have disappeared.
Tacking Beyond Hernia Repair
While hernia repair is the most common setting, tacking also appears in orthopedic surgery. Bioabsorbable tacks have been used to reattach the labrum (the cartilage rim around the shoulder socket) during arthroscopic shoulder stabilization procedures. They’ve also been tested for rotator cuff repairs, where the goal is to anchor soft tissue back to bone. In these cases, the tack serves a similar function: holding tissue in the correct position while the body’s own healing takes over.
Pain and Complications
The most common issue with tacking is postoperative pain. Each tack penetrates tissue, which can irritate nearby nerves, bone, or the peritoneum (the membrane lining the abdomen). This irritation is the primary driver of both short-term and chronic pain after hernia repair with tacks. Tacks can also compress tissue in a way that damages small blood vessels and lymphatic channels, which sometimes leads to fluid collections like seromas or haematomas at the surgical site.
In rare cases, tacks (or the mesh they secure) can migrate over time. When this happens, symptoms range from chronic intermittent abdominal pain to more serious problems like bowel obstruction, abscess formation, or fistulas. Migration is uncommon, but persistent or unusual abdominal pain after a hernia repair warrants imaging to check whether the hardware has shifted.
How Tacking Compares to Glue Fixation
Surgical glue, specifically fibrin glue, has emerged as the main alternative to tacking. Rather than puncturing tissue, glue spreads adhesive force across the entire surface of the mesh. A meta-analysis of 11 randomized controlled trials found that glue fixation significantly reduced both acute pain (within the first three months) and chronic pain compared to tacks. Patients whose mesh was glued also returned to normal activity about two days sooner and had a significantly lower rate of haematoma formation.
The critical question with any alternative to tacking is whether the hernia comes back. In that same analysis, the two-year recurrence rate was nearly identical: 2.0% for glue and 1.8% for tacks. Separate comparisons of tacks versus sutures have shown similarly equivalent recurrence rates, around 7 to 10% depending on the hernia type and follow-up period. So the choice between fixation methods comes down mostly to pain, recovery speed, and cost. Tacks are actually about 70% more expensive than fibrin glue per procedure, and their higher complication rates add further cost through longer recovery times.
Recovery After a Tacking Procedure
There are no universal guidelines for how long to rest after a hernia repair involving tacks, but expert consensus from the European Hernia Society provides a useful framework. For laparoscopic groin hernia repairs, more than half of surveyed surgeons consider two weeks of avoiding heavy physical strain to be sufficient before resuming full activity, sports, and demanding work. For open incisional hernia repairs or procedures involving larger mesh placements inside the abdomen, the consensus shifts to four weeks. Complex hernia repairs may require longer rest, though opinions vary.
In practice, your surgeon will tailor these timelines based on the size of the repair, the type of tacks used, and how your recovery progresses. Light walking and daily activities are generally encouraged soon after surgery, while heavy lifting and intense exercise are the activities that need the waiting period.
Newer Alternatives to Tacking
Beyond glue and sutures, self-gripping mesh represents a newer approach that eliminates the need for any separate fixation device. This mesh has tiny hooks or microgrips built into its surface that latch onto tissue on contact, similar to how Velcro works. Because nothing penetrates the tissue, self-gripping mesh is classified as an atraumatic fixation method. It is increasingly used in both open and laparoscopic repairs, though it is typically studied as its own category rather than being compared head-to-head with tacks in clinical trials.