A new semiresorbable mesh for primary inguinal repair: a preliminary observational study on quality of life and safety (original) (raw)
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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.
Pakistan Journal of Medical and Health Sciences
Background: Various types of meshes for inguinal hernias have been discovered to combat with chronic groin pain related problems. The data regarding these findings was variable due to difference in the cut off values used in the past in different studies to label inguinodynia and local data was scarce where HWM is still highly practiced. Aim: To compare the mean postoperative inguinodynia in patients undergoing open inguinal hernia surgery with use of standard polypropylene heavy weight mesh (HWM) v/s Ultra Pro lightweight mesh (LWM). Methodology: This is a prospective randomized controlled trail conducted at department of surgery, Services Institute of Medical Sciences, from July 2019 to June 2020. Cases were divided in two groups by using radio opaque sealed envelopes labeled as A and B. Group-A underwent Lichtenstein mesh repair by Ultra Pro LWM and group B had polypropylene heavy weight mesh (HWM). Lichtenstein mesh repair was done under spinal or general anesthesia by the exper...
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.
Hernia : the journal of hernias and abdominal wall surgery, 2011
Tension-free repair with mesh placement has become the gold standard for open inguinal hernia surgery. Traditionally, non absorbable materials have been used for mesh manufacture. The purpose of this pilot study was to evaluate the efficacy of using a totally absorbable prosthetic mesh for open inguinal hernia repair. Ten patients with elective inguinal hernias were set to undergo open tension-free inguinal hernia repair with the use of polyglycolic acid-trimethylene carbonate absorbable mesh. In this pilot study, we looked primarily at recurrence and chronic pain assessed 1 year after the operation, while immediate postoperative complications were also recorded. All patients were discharged from the hospital the day after surgery. In three patients (30%), a Foley catheter was inserted to relieve symptoms of urinary retention. None of the patients had any immediate postoperative complication. At the 1st year follow up, none of the patients had clinical signs of recurrence. However, ...
Hernia : the journal of hernias and abdominal wall surgery, 2011
Biologic prostheses are designed to support tissue regeneration rather than just result in a strong scar plate, as is the case with synthetic mesh. It is not known if these newer materials will result in earlier return to normal activities and/or less post-herniorrhaphy groin pain. METHOD/STUDY DESIGN: A prospective, randomized, controlled, third-party-blinded multicenter trial was designed to compare the use of a non-cross linked porcine dermis biologic graft [Strattice(TM) Reconstructive Tissue Matrix (RTM), LifeCell, Branchburg, NJ] versus light weight, large pore polypropylene mesh (UltraPro(TM), Ethicon, Somerville, NJ). The study design called for recruitment of 170 men. These men are being followed for a minimum of 2 years. The primary aim of this study is to compare the safety and effectiveness of the two materials in a Lichtenstein inguinal hernia repair as measured by resumption of activities of daily living. Secondary outcomes include chronic pain, postoperative complicat...
International Surgery Journal, 2017
Background: Inguinal hernia repair is one of the most common surgical procedures performed in practice. Although numerous techniques have been described, currently tension free mesh repair is the standard of care in the treatment of hernias because of the low recurrence rates. Methods: A comparative study between Light and Heavy Polypropylene mesh in Lichtenstein repair of inguinal hernia was conducted at Department of General Surgery in MVJ Medical college and Research Hospital, Hoskote, Bangalore on patients admitted in Department of General Surgery between November 2014 to July 2016 undergoing Lichtenstein tension free mesh repair for inguinal hernia. The study is a prospective study. 30 Patients were in Light mesh group and 30 were in Heavy mesh group. Results: Age group of 31-40 yrs had highest incidence of inguinal hernia. Males outnumber Females in incidence of Inguinal Hernia. Foreign body sensation in Heavy mesh group is significantly high. Average of 26.7% of the patients had foreign body sensation in Heavy mesh group. Whereas in Light group average was 10%. Chronic pain also showed significant readings in Heavy mesh group. Stiffness over abdominal wall was complained by 10% of patients overall in the light mesh group whereas no patients had this complaint in light mesh group. Recurrence was high in light mesh group where total of 5 patients had recurrence and in heavy there were only 2 patients with recurrence. Conclusions: In my study light mesh has been proved to be better than heavy mesh in treatment of inguinal hernia.
A Novel Use of Fully Absorbable PhasixTM Mesh for Laparoscopic Inguinal Hernia Repair
JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, 2020
Background and Objectives:An inguinal hernia is usually repaired with synthetic nonabsorbable mesh, resulting in collagen formation, chronic inflammation, and fibrosis, with significantly reduced hernia recurrence. However, chronic pain may affect the quality of life. Poly-4-hydroxybutyrate (P4HB) mesh was introduced to minimize complications, and starts to degrade in 12–18 months. This study assesses the consequences and results of patients undergoing transabdominal preperitoneal (TAPP) inguinal hernia repair using P4HB mesh (PhasixTM, C.R. Bard Inc., Murray Hill, NJ, USA).Methods:We performed a pilot study of laparoscopic TAPP repair for inguinal hernias using P4HB mesh in 15 patients (14 male and one female) with an average age of 55.8 y, and an average body mass index of 27.4 kg/m2. We assessed the recurrence rate and patients' chronic pain for 30 months, with institutional review board approval (E-19–3735). The study was conducted from January 2016 to July 2017 in Medical City, King Saud University. We measured postoperative pain, reactions, mesh sensation, discomfort, and recurrence.Results:In 15 patients, we encountered no recurrence or mesh sensation, except in one patient, who experienced mild chronic inguinal pain for one year, without activity restrictions.Conclusion:Laparoscopic TAPP inguinal hernia repair using P4HB mesh is safe for combined, direct (medial), and indirect (lateral) inguinal hernia, with no recurrence. P4HB absorbable mesh caused less chronic pain and discomfort. Longer follow-up, more patients and 15 patients repaired using synthetic mesh are necessary to assess the utility of P4HB for inguinal hernia repair globally.
World Journal of Surgery, 2007
Background The Prolene hernia system (PHS) is a threedimensional mesh device that combines three approaches to hernia repair, but its high cost precludes its widespread use in developing countries. We describe our experience with an indigenous bilayer mesh device that works on a similar principle, and compare its efficacy with conventional PHS. Materials and Methods A total of 84 patients with unilateral/bilateral primary uncomplicated inguinal hernia were recruited for the study over a 1-year period and randomized into two groups. Group 1, which consisted of 40 patients, received the indigenous device, and group 2, 44 patients, received conventional PHS. Mean operative time and the patients' visual assessment scores (VAS) for pain were primary outcome measures. Patient were reviewed in out patients department at intervals of 3 months, and the incidence of complications and recurrence was noted. This was the secondary outcome measure. Results The two group were comparable in terms of age, type of hernia, and mean duration of follow-up. The mean operative time was 32.1 min (± 5.5) and 33.25 (± 5.3) in groups 1 and 2, respectively, and the mean VAS score was 2.25 and 2.27 in the respective groups. There was no statistically significant difference. Similarly, the was no significant difference in incidence of complications noted between the two groups (3/40 versus 4/44, respectively). There were no recurrences noted during the period of observation. Conclusions The indigenous bilayer device described in this study combines the advantages of two well-publicized techniques of hernia repair: inlay repair and onlay repair. It offers the benefits of conventional PHS repair but is far less expensive and is quite suitable for routine use in centers like ours in a developing nation, where financial resources are a constraint. The polypropylene hernia system (PHS) has been popularized recently as a three-dimensional mesh device for repair of adult inguinal hernia. However, the higher cost of PHS as compared to the conventional polypropylene mesh makes its widespread use difficult in developing countries like ours [1]. We describe a simple bilayer mesh repair device, our experience with its use, and a cost analysis comparing it to conventional PHS. Materials and methods Patient selection All patients with primary inguinal hernia reporting to our surgical outpatient department between January 2005 and January 2006 were assessed. Cases of primary inguinal hernia, unilateral or bilateral, were included in the study. These patients were then randomized into two groups, by an independent observer using a random number generator. The independent observer was not thereafter involved in surgery per se or subsequent follow-up. Recurrent inguinal hernia and complicated inguinal hernia were excluded from
International Surgery Journal, 2021
Background: Inguinal hernia, the most frequently occurring type of hernia globally, Chronic groin pain could be related to nerve mangling while operating. Mesh repair can lead to an inflammatory reaction over a period of time, though it still needs ground work to find out exact cause of pain. So this study aims to compare the effectiveness of polyglactin versus prolene sutures in reducing the post-operative pain in inguinal hernia repair.Methods: A one year hospital prospective study in KLE hospital. A total of 60 adult patients were divided into two groups of 30 each. Mesh fixation with polyglactin sutures was group A (30) and mesh fixation with polypropylene sutures was group B (30) and then post-operative pain, was assessed. Follow-up was for 3 months. Collected data was analyzed using chi–square tests, Mann-Whitney U tests.Results: Our analysis showed that the incidence of postoperative groin pain with mean severity scores of 1.37±0.49 versus 1.43±0.50; 1.40±0.50 versus 1.57±0.7...