Traditional polypropylene and lightweight meshes in totally extraperitoneal inguinal herniorrhaphy (original) (raw)
Related papers
Langenbeck's Archives of Surgery, 2011
Background Early post-operative pain after inguinal hernia repair delays management in ambulatory setting. The type of mesh used for repair appears to influence their incidence. Aims The aim of this randomized, prospective study using the alternation principle was to compare post-operative early pain and the quality of life of patients operated on for inguinal hernia depending on the type of mesh used and their impact on management in ambulatory setting. Patients and methods Fifty successive patients were included prospectively. Hernia repair was performed using the Lichtenstein procedure with two types of mesh, namely standard polypropylene 100 g/m 2 (Prolène®) or light polypropylene (55 g/m 2 ) with a natural beta-D-glucan coating (Glucamesh®). The main assessment criterion was post-operative pain evaluated twice daily by the patient for 7 days, using the visual analogue scale (VAS) and their use of analgesics. The secondary assessment criteria were the rate of unscheduled admissions the evening of the intervention and the hospital length of stay and the quality of life evaluated by the SF12 questionnaire at pre-operative stage and on days 7 and 30. Results The two groups were comparable. The operative durations were identical (38.8±10.2 vs 48±15.4 min). On the evening of the intervention before discharge, the pain was less intense in the Glucamesh® group (mean VAS score 21.6±2.4 vs 31.7±6.2, p=0.02). On day 4, 20% of patients from the Glucamesh® group and none of the patients from the Prolène® group had a VAS score of 0 (p=0.02). There were no unscheduled admissions in either group, but the hospital stay was significantly shorter in the Glucamesh® group compared with the Prolène® group (288±35 vs 360±48 min, p=0.02). The post-operative quality of life evaluated by the SF12 questionnaire from day 7 to day 30 was the same in both groups (38±4.8 vs 37±5.2) and altered as at pre-operative stage compared with a control population (normal=50). Conclusions This randomized, prospective study showed that the use of a self-adhesive, light mesh, reducing the fixation sutures and coated with factors favouring tissue integration, such as the Glucamesh® prosthesis, significantly reduced early post-operative pain compared with conventional prostheses and could increase the percentage of patients likely to undergo an ambulatory hernia repair.
The Egyptian Journal of Hospital Medicine, 2019
Background and aim: the ideal outcome of inguinal hernia surgery is to provide a repair that is free from recurrence, pain and infection with minimal scarring and with improvement in patient's quality of life. Aim of the work: this study aimed to compare light weight poliglecaprone (Ultrapropolypropylene/Monocryl), UltraPro™ mesh with the standard heavy weight polypropylene mesh in tension free Lichtenstein inguinal hernia repair. Patients and methods: the current study included 40 patients complained of uncomplicated inguinal hernia and they were randomized into two groups according to the type of mesh used in tension free Lichtenstein inguinal hernia repair. Group I, 20 patients received the standard polypropylene mesh. Group II, 20 patients received light weight UltraPro™ mesh, using sutures for their fixation. Results: the UltraPro™ (LWM) mesh proved to be as safe and effective as the standard (HWM) prolene mesh in repair of uncomplicated inguinal hernia. There was no difference between the two groups as regard to the technical difficulties, operative complications and surgeons were equally satisfied. There was more incidence of chronic pain with prolene mesh (25%) compared to (zero%) with UltraPro™ mesh. The mesh fixation time and the overall operative time were shorter with UltraPro™ mesh. Conclusion: the shorter operative time and the no-need to use analgesics could partially compensate the higher cost of UltraPro™ mesh in the absence of other economic factors such as the duration of patient improvement and return to work.
Hernia, 2008
Background In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro-Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. Methods Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identiWed from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. Results Two hundred and Wfty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically signiWcant diVerences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. Conclusion In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.
Prosthetic mesh reinforcement is now routine in the management of inguinal hernia but can cause considerable pain and stiffness around the groin. The aim of this study was to compare the outcome after laparoscopic TEP inguinal repair using new lightweight or traditional heavyweight mesh performed in a single unit. Between November 2004 and March 2005, 113 patients underwent laparoscopic TEP inguinal repair using either lightweight (28 g/m 2 ) or heavyweight (85 g/m 2 ) mesh. Follow-up data was obtained using case note review and telephone-based questionnaire in April 2005. Follow-up information was obtained for 93 (83%) out of 113 patients. There was no difference between the two groups in the incidence of pain/discomfort at mean 3-month follow-up (45 vs 41%, Mann-Whitney U, P=0.641). However, there was a significant inverse correlation between the length of time since operation and severity of pain/discomfort in the lightweight group (P=0.001, Pearson test), suggesting a faster speed of recovery with lightweight mesh. Laparoscopic TEP inguinal hernia repair with lightweight mesh yields promising early results. Whilst there was no significant difference in pain or recurrence in the short term, postoperative pain scores improved earlier in patients with lightweight mesh compared to heavyweight mesh. This merits further study, with larger cohorts and longer follow-up, to determine the benefits of lightweight mesh.
Hernia, 2008
Background In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro—Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. Methods Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identified from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. Results Two hundred and fifty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically significant differences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. Conclusion In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.
Background Prosthetic mesh reinforcement is standard practice for inguinal hernia repair but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in a lighter weight mesh. The aim of this prospective study was to compare the outcome after laparoscopic totally extra-peritoneal (TEP) inguinal repair using new lightweight or traditional heavyweight mesh performed in a single specialist centre. Methods Between November 2004 and July 2005, 250 patients underwent laparoscopic TEP inguinal repair using either lightweight (Ultrapro Ò , 30 g/m 2 ) or heavyweight (Prolene Ò , 100 g/m 2 ) mesh. Follow-up data was obtained using case note review and telephone-based questionnaire. Patients were followed up within the early and late postoperative periods to assess any changes in outcome. Results Follow-up information was obtained for 188 (75%) out of 250 patients. There was no difference between lightweight and heavyweight groups in the incidence or severity of pain/discomfort at mean 4 and 15 months follow-up. There was significantly less interference with physical activity at short and long term follow-up in the lightweight group, in particular lifting (9% vs 21% at mean 4 months, Mann-Whitney U, P = 0.024), walking (1% vs 11% at mean 15 months, Mann-Whitney U, P = 0.006) and vigorous activities (7% vs 19% at mean 15 months, Mann-Whitney-U, P = 0.012). There was no significant difference in awareness of mesh or stiffness in the groin. Conclusions Laparoscopic TEP inguinal hernia repair with a lightweight mesh improves functional outcome in the short and long term. There was significantly less interference with all aspects of physical activity with the lightweight mesh. Pain in both groups was very mild, highlighting the benefits of laparoscopic surgery.
Current Medicine Research and Practice, 2020
Aims: Outcomes after Totally Extraperitoneal Repair (TEP) for groin hernia are being increasingly studied in the quest for an ideal mesh and ideal technique. The aim of this study is to evaluate short term outcomes of these pre-shaped 3D meshes without fixation and comparing their results to flat meshes with fixation in patients undergoing unilateral or bilateral totally extra-peritoneal repair for groin hernia. Methods: A total of 71 consecutive patients admitted for endoscopic groin hernia repair in the Department of General and Laproscopic surgery were included in the study from March 2015 to May 2016. All patients underwent TEP using either a flat polypropylene mesh fixed with tacks or a 3-D polypropylene mesh without fixation. Parameters assessed at the follow up were early post operative pain by VAS score, chronic groin pain and recurrence. Results: Early postoperative pain in fixation group was relatively higher compared to non-fixation group. There was no statistically significant difference between the two groups in incidence and severity of chronic groin pain at 6 months. Only one patient in the study in the flat mesh group had symptomatic recurrence of hernia 10 months after surgery. Mesh deployment time was significantly lower with preshaped mesh. Conclusion: Use of a pre-shaped contoured mesh without the use of any additional fixation during TEP repair is feasible and safe. The incidence and severity of postoperative chronic pain is similar if preshaped mesh is used without fixation without any increase in recurrence in experienced hands.
Surgical Science, 2013
Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene ® , Covidien, France), and a polyester mesh (Parietex ® , Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on days 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.
International Surgery Journal
Background: Polypropylene mesh gives risk of recurrence, owing to overall decrease in the size of mesh and increased subjective foreign body feeling from contracture and scarring. An anatomically contoured 3D mesh for laparoscopic inguinal hernia repair often requires no fixation, with minimal risk of postoperative pain and recurrence rate.Methods: This was a prospective comparative study conducted over a period of 2.5 years. The study enrolled 60 patients, 30 patients in each group. The end points of the study were mesh fixation time, post-operative pain, seroma formation, hospital stay, chronic groin pain, sensory impairment, and cost and affordability. Follow up period was 18 months.Results: The mesh fixation time was less in 3D mesh, 10.6±4.31 minutes (p value- 0.0002). The incidence of severe immediate postoperative pain was higher in polypropylene mesh 10% (p value of 0.612). The postoperative seroma was less in 3D mesh, 3.3% (p value of 1.00). The mean hospital stay was short...