Introduction 1 Patients and methods n n n ® ® n n 2 ® t P Results P Mean postoperative hospital stay was identical for both groups and equaled 1 day. Postoperative complications included seroma lasting longer than 6 weeks in seven patients and chronic pain at TAS sites in one patient. All seromas resolved without intervention. The patient with persisting pain underwent relaparoscopy and removal of all eight TAS that provided complete pain relief. There were no significant differences in morbidity between the two groups. No recurrences were detected during a mean follow-up of 26.4 ± 25.6 months. Discussion 3 4 5 2 6 1 We decided to compare the two techniques in a maximally homogenous model of the procedure: same site of hernia, same logistics of the operation, same prosthetic material, same fixation device, and same operation technique until the moment that the outer ring of tackers is completed. The only difference between the two techniques was the completion of the mesh fixation. In one technique eight TAS had to be inserted and in the other technique usually 6–8 tackers of the inner crown. Once the fixation had been completed, whatever the method was, the rest of the procedure was again identical. Obviously, the difference in operative times between the two operative techniques can be entirely accounted to the difference in time needed for insertion of eight TAS compared to the time needed for application of an inner crown of tackers. Since tacking of the inner crown takes definitely not more than 1 min in laparoscopic repair of PUH, insertion of eight TAS required at least 8 min. This strongly indicates that insertion of every single TAS prolongs LRVIH by approximately 1 min. A laparoscopic repair of PUH is definitely the least complex procedure among all LRVIHs. Insertion of TAS is probably easier than in other LRIVHs due to a central location of the hernia, a general absence of adhesions, maximal space between the distended abdominal wall and the bowel underneath, and an excellent view. It may be anticipated that insertion of TAS during more complex laparoscopic repairs of incisional hernias at less suitable sites, in the presence of adhesions and proximity of the bowel can be much more challenging and as a consequence will require more time than during repair of a PUH. Our results indicate that LRVIH by using the DC technique indeed requires less operative time than when the TAS technique is used. As long as no significant differences between the two fixation techniques are demonstrated on issues of recurrence, complications, and postoperative pain, the time difference we have measured might be an argument in favor of the DC technique, especially when mesh fixation would require a large number of TAS.