Heavyweight Mesh Improves Laparoscopic Repair Of Inguinal Hernia
The use of heavyweight mesh for laparoscopic total extraperitoneal inguinal hernia repair is associated with less pain and fewer recurrences, compared with lightweight mesh, researchers from the Netherlands report.
“There is no benefit of lightweight over heavyweight meshes,” Dr. Josefina P.J. Burgmans from Diakonessenhuis Utrecht/Zeist, Utrecht, told Reuters Health by email.
In open anterior inguinal mesh repair, lightweight meshes have been associated with less pain and foreign body feeling, but these benefits have not been demonstrated in laparoscopic repair, and there is no consensus as to which type of mesh is optimal in these procedures.
Dr. Burgmans’ team compared rates of chronic pain, mesh awareness and hernia recurrence, as well as quality of life, up to two years after total extraperitoneal hernia repair with lightweight or heavyweight mesh in a randomized trial of 950 men.
Moderate to severe pain at one year was significantly more common with lightweight mesh (2.9%) than with heavyweight mesh (0.7%). This difference persisted at the 2-year mark, according to the May Annals of Surgery report.
In multivariable analysis, lightweight mesh was associated with a 3.96-fold higher risk of moderate to severe pain at one year.
Recurrence rates in the first two years after surgery were significantly higher with lightweight mesh, even after correcting for other factors.
The proportion of men reporting foreign body feeling, testicular pain, and sexual-related pain and discomfort did not differ significantly between the two treatment groups.
“I would advise to use Prolene (heavyweight mesh) in all cases,” Dr. Burgmans said. “The results of Prolene are excellent in high-volume centers with experienced surgeons.”
Dr. Tim Verhagen from Maxima Medical Center, Veldhoven, the Netherlands, who has investigated several approaches to treating inguinal hernia, told Reuters Health by email, “Although the difference in relevant chronic pain in this trial may be statistically significant, its clinical relevance is doubtful (especially concerning the statistical points made above). The higher recurrence rate in the lightweight group may be a bigger cause for concern and warrants further investigation.”
“In light of this study, the current evidence, and our own results,” he said, “I feel that the type of mesh used in inguinal hernia repair should be patient-tailored, weighing the risk of chronic pain versus the risk of recurrence.”
“Patients with a high recurrence risk and a low risk for chronic pain (i.e., an asymptomatic patient with a large hernia defect and an abdominal aneurysm) might benefit more from a heavyweight mesh, while others with smaller defects and no risk factors may be better off with a lightweight mesh,” Dr. Verhagen said. “Determining whether this is the case or not will, however, require more research.”
“All the operations in this study were performed by highly experienced, expert surgeons,” he added. “This does not reflect the general situation and makes generalization of these results difficult.”
The authors reported no study-related funding or disclosures.