Randomized clinical trial comparing lightweight mesh with heavyweight mesh for primary inguinal hernia repair

Purpose

The aim of the present randomized clinical trial was to compare feeling of a foreign body and the early and late outcomes after inguinal hernia repair with the heavyweight (HW) mesh and lightweight (LW) mesh during a 12-month follow-up at a single specialist center.

Materials and methods

One hundred and ten patients were randomized into HW and LW mesh groups, both of which underwent unilateral primary inguinal hernia via the Lichtenstein technique. At each postoperative visit, any complication, recurrence, feeling of a foreign body, quality of life, residual pain, and numbness were recorded.

Results

Complaint of feeling of a foreign body on the repaired side was more frequent in the HW mesh group than in the LW mesh group (P < 0.05). Fewer patients in the LW mesh group reported postoperative numbness around the groin or down the thigh than did those in the HW mesh group (P < 0.05). At 12-month follow-up, however, there was no difference between the LW and HW mesh groups as regards the incidence or severity of pain or discomfort and recurrence rate and nor was there any significant dissimilarity between the two study groups in any dimension of quality of life on the SF-36.

Conclusion

There was no significant difference between our LW mesh and HW mesh groups in terms of chronic pain incidence, recurrence rate, and quality of life following inguinal hernia repair. However, fewer patients in the LW mesh group reported numbness around the groin or down the thigh postsurgery than did those in the HW mesh group and therein may lie in the superiority of LW mesh for inguinal hernia repair. Larger cohort studies with longer follow-up periods are required to elucidate in the future the benefits of the LW mesh.     

Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair

BACKGROUND: Severe chronic pain is a long-term problem that may occur after inguinal hernia repair. The aim of this randomized study was to compare pain of any severity at 12 months after inguinal hernia repair with a partially absorbable lightweight mesh (LW group) or with a non-absorbable heavyweight mesh (HW group). METHODS: Patients were assessed for pain at 1, 3 and 12 months by questionnaire, and were examined clinically at 12 months. RESULTS: Some 321 patients were included in an intention-to-treat analysis, 162 in the LW group and 159 in the HW group. At 12 months, significantly fewer patients in the LW group than in the HW group had pain of any severity: 39.5 versus 51.6 per cent (difference-12.1 (95 per cent confidence interval-23.1 to-1.0) per cent; P = 0.033). The recurrence rate was higher in the LW group (5.6 versus 0.4 per cent; P = 0.037). Five of eight recurrences in LW group were associated with a single participating centre. CONCLUSION: Use of lightweight mesh was associated with less chronic pain but an increase in hernia recurrence after inguinal hernia repair. The latter may be related to technical factors associated with fixation of such meshes rather than any inherent defect in the mesh.     

Randomized clinical trial comparing lightweight or heavyweight mesh for mesh plug repair of primary inguinal hernia

Background

The aim of this study was to assess whether the application of a lightweight mesh for mesh plug repair (MPR) for primary inguinal hernia could reduce chronic pain or other symptoms associated with the insertion of the prosthesis.

Methods

Patients over 20 years of age with a unilateral primary inguinal hernia were eligible to participate in the study. The patients were randomly assigned to a lightweight mesh (LWM) or a heavyweight mesh (HWM) group. All the operations were performed under local anesthesia. The operative details, including the hernia type and the nerves that were identified, and the postoperative complications were recorded. All follow-up and outcome measures were obtained based on a physical examination and a questionnaire regarding pain and other symptoms at 1 week, 1, 3, 6, and 12 months after the surgery in a double-blinded manner.

Results

The use of LWM significantly reduced foreign body sensation after 12 months to one-third of the incidence reported for the use of HWM (5.8 vs. 17.9 %; P = 0.013), while no significant differences were found in pain parameters, including the use of pain relief medications, between the groups throughout the study period.

Conclusion

This study indicated that the use of LWM in the MPR decreases the incidence of foreign body sensation at 1 year after surgery for primary inguinal hernia. LWM may be preferable to MPR, similar to results described previously for Lichtenstein repair.     

Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia

Background  

This prospective, clinical, randomized, controlled study was performed to define the incidence of chronic pain after total extraperitoneal (TEP) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias.     

Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair

Background  

The purported advantage of lightweight large-pore meshes is improved biocompatibility that translates into lesser postoperative pain and earlier rehabilitation. However, there are concerns of increased hernia recurrence rate. We undertook a prospective randomized clinical trial to compare early and late outcome measures with the use of a lightweight (Ultrapro) mesh and heavyweight (Prolene) mesh in endoscopic totally extraperitoneal (TEP) groin hernia repair.     

重量型补片与轻量型补片应用于腹股沟疝修补术的Meta分析

目的评价重量型补片与轻量型补片应用于腹股沟疝无张力修补对患者恢复的影响。方法检索PubMed、EMBase、Springer及Cochrane图书馆,结合查找到文献中的参考文献,检索时间从2000年1月至2010年9月,选择有关重量型补片与轻量型补片应用于腹股沟疝修补术的临床对照研究,由两位作者分别对研究质量进行评估,并提取有关资料,主要包括术后复发、血肿与血清肿、异物感,感染及疼痛的情况,采用RevMan5.0软件进行Meta分析。结果共纳入21项临床对照研究,其中16项为前赡性随机对照临床研究,包括5389例,其中重量型补片组2861例,轻量型补片组2528例。对纳入研究进行整体分析显示,轻量型补片组术后异物感发生率明显少于重量型补片组（p〈0.05）,优势比（Odds ratio）及95%可信区间为1.90（1.48,2.43）,轻量型补片组术后慢性疼痛（12个月或更长）的发生率明显少于重量型补片组（p〈0.05）,OR及95%可信区间为1.39（1.10,1.75）;两组患者在术后的复发、血肿（血清肿）、感染及早期疼痛的发生率无显著差异（p〉0.05）。结论使用轻量型补片进行腹股沟疝无张力修补术,能减少术后的异物感及慢性疼痛,对术后的复发、血肿（血清肿）、感染及早期疼痛无明显影响。     

Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty

Purpose  

The aim of the present randomised clinical study was to compare the incidence of post-operative chronic groin pain and the feeling of a foreign body after inguinal hernioplasty with lightweight (LW) and heavyweight (HW) mesh, as well as to evaluate the patient’s quality of life after inguinal hernia repair.     

Chronic pain and discomfort after inguinal hernia repair

Purpose

The purpose of this study was to estimate the incidence and degree of persistent chronic pain after inguinal hernia repair performed in our hospitals.

Methods

We mailed a questionnaire on the frequency and intensity of postoperative inguinal pain and discomfort to 219 adult patients who had undergone inguinal hernia repair in one of our hospitals more than 3?months previously.

Results

There were 191 (87.2%) respondents, 28 (14.7%) of whom reported pain and 33 (17.3%) reported discomfort. The frequency of pain was “rare” in more than half of the patients who reported pain. No patient reported “continuous” pain. The intensity of the pain was “mild” in most of the patients, and none reported “pain that required a painkiller”. The answers on the face scale questionnaire (score “0” to “10”) were “0” or “1” for most of the patients. The incidence of chronic pain and/or discomfort was significantly higher in women than in men, and tended to be higher in patients who had undergone repair using onlay mesh.

Conclusions

The frequency and intensity of persistent chronic pain or discomfort after inguinal hernia repair was not high or severe. These data will be useful for further studies to determine the best treatment for adult inguinal hernia.     

Three-year results of randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty

Purpose

The aim of the present randomised study was to find out whether usage of lightweight mesh in inguinal hernia repair, compared with heavyweight mesh, results in decreased incidence of chronic groin pain and foreign body feeling, as well as to evaluate the risk factors for chronic pain development and hernia recurrences.

Methods

The patients were randomised into the heavyweight mesh (HW) group and lightweight mesh (LW) group. A tension-free mesh repair using the Lichtenstein technique was performed on all patients. Pain scores during different activities were measured on visual analogue scale. All patients underwent a clinical examination for any evidence of hernia recurrence.

Results

Of the patients, 17.2?% in the HW group and 29.3?% in the LW group reported that they experienced pain at 3-year follow-up (P?=?0.1323). Pain was most often reported during physical activity. The median VAS score of all studied activities was 30.5 in the HW group and 30.0 in the LW group. There were more patients in the HW group than in the LW group who stated that they could feel the mesh in the groin (27.6 vs. 20.7?%, P?=?0.3967). Among all patients, 42.9?% who had severe pain preoperatively also reported pain during different activities and 19.6?% of the patients who did not have severe pain preoperatively reported pain during different activities (P?=?0.0481). At 3-year follow-up, there was 1 hernia recurrence in the HW group and 1 hernia recurrence in the LW group.

Conclusions

Our study shows that compared with HW mesh, LW mesh has no advantage in reducing chronic groin pain and foreign body feeling at the operation site after inguinal hernioplasty at 3-year follow-up. Severe preoperative pain was correlated with the development of chronic pain. There was no difference between the two study groups in the recurrence rates.     

轻型补片与传统补片在腹股沟疝修补术中有效性和安全性的荟萃分析

目的系统评价轻量型补片与传统补片在腹股沟疝修补术中的有效性和安全性。 方法计算机检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、中国科技期刊全文数据库、中国期刊全文数据库。全面收集比较轻量型补片与传统补片在腹股沟疝修有效性和安全性的随机对照试验（randomized controlled trials,RCTs）,2名评价者独立评价纳入文献的方法学质量,用RevMan 5.3软件进行统计分析。 结果共纳入19篇RCTs,Meta分析结果显示,轻量型补片组与传统传统补片组患者在复发率方面比较,差异无统计学意义[RR=0.82,95% CI（0.56～1.19）,P=0.30];在慢性疼痛[RR=0.68,95% CI（0.57～0.81）,P<0.000 1]、异物感[RR=0.67,95% CI（0.56～0.81）,P<0.000 1]及其并发症[RR=0.63,95% CI（0.51～0.77）,P<0.000 1]方面比较,差异均有统计学意义。 结论轻量型补片与传统传统补片在无张力疝修补术中的复发率方面相似,而轻量型补片减轻慢性疼痛、异物感及并发症发生方面优于传统补片。     

Chronic pain and quality of life following open inguinal hernia repair

BACKGROUND: The aim was to determine the frequency and characteristics of chronic pain following open inguinal hernia repair and to identify risk factors for its development. METHODS: This was a questionnaire survey of a historical cohort of patients who underwent inguinal hernia surgery in Aberdeen. The sample comprised all patients (n = 351) who underwent surgery between January 1995 and December 1997, and who were alive and resident in Grampian in October 1999. Outcome measures included self-report of pain persisting for more than 3 months after operation. Pain was characterized by means of the McGill Pain Questionnaire, and quality of life was assessed with the Short Form 36 (SF-36). RESULTS: A total of 226 patients (64 per cent) completed the questionnaire, 67 (30 per cent) of whom reported chronic pain. Reported pain was predominantly neuropathic in character. Patients at increased risk of chronic pain were under 40 years old (P < 0.001), had day-case surgery (P = 0.004), had subsequent surgery on the same side (P < 0.005) and recalled pain before operation (P = 0.005). The SF-36 scores were significantly different in the social functioning, mental health and pain dimensions in patients with chronic pain. CONCLUSION: Chronic pain occurred in 30 per cent of patients after open hernia repair, a higher frequency than has been reported previously. Several risk factors were identified and further prospective research is recommended.     

Testicular functions,chronic groin pain,and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial

Background  

Laparoscopic inguinal hernia repair is still not the gold standard for patients with inguinal hernia. The aim of this study was to compare testicular dysfunction, incidence and factors influencing chronic groin pain, and quality of life after laparoscopic and open mesh repair.     

Chronic pain after open inguinal hernia surgery: suture fixation versus self-adhesive mesh repair

Purpose

Chronic pain following inguinal hernia repair is a complex problem. Mesh fixation with sutures may be a contributing factor to this pain. The aim of this study was to compare the incidence of chronic pain and limitation of activities of daily living following inguinal hernia repair using a sutured mesh to a self-adhesive mesh, 6?months and 1?year following surgery.

Methods

All consecutive patients presenting to NHS Fife for open hernia repair between January 2009 and January 2010 were included in our analysis. A prospective survey of postoperative pain and activities of daily living was conducted at 6?months and 1?year following hernia repair. Chronic pain was assessed using the SF-36 questionnaire. The primary end points for analysis were incidence of chronic pain and limitation of activities of daily living.

Results

Overall, 132 of 215 patients completed the questionnaire, 69 in the sutured group and 63 in the self-adhesive mesh group. The need for analgesics was similar during the first 24?h after surgery. Wound infections were detected in one patient in the Lichtenstein group and two in the second group. The incidence of chronic pain was 21 and 7.9 % at 6?months and 18.8 and 6.3 % at 1?year (p?<?0.05). Moderate and vigorous activities were found to be limited some to all of the time in nine patients (60 %) in the suture fixation group and in one patient in the self-adhesive group (20 %, p?<?0.02).

Conclusions

Open inguinal hernia repair with a self-adhesive mesh may lead to less chronic pain and less restriction of activities of daily living than a sutured mesh fixation.     

Postoperative pain and quality of life after laparoscopic and open inguinal hernia repair: results of a prospective randomized trial

Background As part of a large prospective randomized Austrian multicenter trial evaluating recurrence rates and complications of open and laparoscopic unilateral inguinal hernia repairs we assessed postoperative pain and quality of life. Methods Approximately 151 patients were randomized to Shouldice repair, Bassini operation, or laparoscopic transabdominal preperitoneal hernioplasty (TAPP). Pain was recorded preoperatively and on the first four postoperative days. Quality of life was recorded preoperatively and 1 month postoperatively. Results Patients having Shouldice repairs had significantly higher visual analog-scale scores for pain on the fourth postoperative day (P=0.048) and significantly higher scores in McGill pain questionnaires on the first four postoperative days (P=0.046) compared with the other groups. Apart from a significantly lower score in postoperative bodily pain in the Shouldice group (P=0.039), no significant differences in quality of life were apparent among the three methods. Conclusions The TAPP and Bassini repairs result in less short-term postoperative pain.     

Shrinkage evaluation of heavyweight and lightweight polypropylene meshes in inguinal hernia repair: a randomized controlled trial

Background  

One of the current complications in inguinal repair is shrinkage following the use of mesh. The selected mesh material, heavyweight (HWM) mesh or lightweight (LWM) mesh, is associated with the frequency of shrinkage. The aim of this study was to investigate shrinkage of these two types of mesh in a controlled trial of male inguinal hernia repair.