Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair

BACKGROUND: Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene Hernia System. The choice of technique may be influenced by the effects on postoperative pain and quality of life. METHODS: A total of 334 patients were allocated blindly and at random to receive one of these three meshes for open hernia repair. Quality of life was assessed with the Short Form 36 and pain by a visual analogue scale 14 days, and 3 and 15 months after surgery. RESULTS: Operative complications were rare and comparable between the groups. Long-term follow-up was completed by questionnaire in 95.8 per cent of patients. There were no significant differences in pain parameters between the three meshes; overall, 43.3 per cent of patients reported some form of groin pain. The severity of the chronic pain correlated with a higher pain score in the first 2 weeks after surgery (P < 0.001). A significant reduction in scores for role emotional (short term) and vitality (long term) quality of life domains was found in patients who had a Lichtenstein repair. CONCLUSION: These short- and long-term results did not show any clinically significant difference in postoperative pain and quality of life between the three types of mesh hernia repair. Severe early postoperative pain reliably predicted the likelihood of persisting chronic groin pain.