Chronic pain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh

Abstract

PurposeThere is a paucity of high-quality evidence concerning mesh choice in open inguinal hernia repair. Using an expertise-based randomized clinical trial design, we aimed to evaluate the postoperative impact of two different mesh types on pain and discomfort, quality of life and sex life.MethodsIn two regional hospitals, male patients with primary inguinal hernia were randomized to one of two groups of surgeons that performed the Lichtenstein operation. One group of surgeons used a heavyweight polypropylene mesh (90 g/m2, Bard™ Flatmesh, Davol) while the second group employed a lightweight mesh (28 g/m2, ULTRAPRO™, Ethicon). Follow-up data were collected by questionnaires and outpatient visits in the range of 1–3 years after surgery.ResultsSome 412 patients were randomized and 363 patients were analysed. There was no difference in pain between groups after surgery but a statistically significant difference concerning awareness of a groin lump and groin discomfort, favouring the lightweight group 1 year after surgery. No differences in quality of life between groups could be detected but both groups had a substantially better quality of life postoperatively, as compared to before surgery. In the analysis of impact on sex life, no differences between mesh groups were found.ConclusionThe Lichtenstein operation performed for primary inguinal hernia improves quality of life for most of the male patients, independently of the type of mesh used. The lightweight mesh group experienced less awareness of a groin lump and groin discomfort 1 year postoperatively.ClinicalTrials.gov Identifier: NCT00451893.

The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia

“…The promising results in using mesh implants for other hernia types [ 27 , 28 , 29 , 30 ] have encouraged the implantation of meshes also in the treatment of parastomal hernia and for prophylactic purposes.…”

The Impact of Open Inguinal Hernia Mesh Repair on Quality of Life

“…This might be a triggering factor for men having a higher incidence of inguinal hernia. Regarding the relation between age and inguinal hernia, it has been found that the inguinal re-Table1: Carolinas Comfort Scale questionnaire (7).…”

“…Both the technical differences and also different meshes are evaluated concerning their impact especially on movement ability and groin pain in different studies. Rutegard et al (7) found no statistical difference between light or heavyweight polypropylene mesh patients regarding QoL scores. Sanders et al (8) reported no significant superiority of mesh fixation technologies including fibrin sealants, self-fixing meshes and NB2C glues over conventional suture fixation on postoperative quality of life.…”

Meta-Analysis of Randomized Controlled Trials Comparing Lightweight and Heavyweight Mesh for Laparoscopic Total Extraperitoneal Inguinal Hernia Repair

“…There were several studies that reported higher recurrence rates after TEP herniorrhaphy with a lightweight mesh. 8,13,18,23 The efficacy of mesh repair to prevent recurrence is based on the strengthening of weakened native tissue by a strong mesh aponeurosis scar tissue complex, formed by inflammatory response induced by the mesh material. 25,26 The mass of the implanted material and its pore size were assumed as the main factors for the intensity of this reaction.…”

“…7 Compared with heavyweight meshes, less foreign body feeling and chronic pain were described when a lightweight mesh was used in open inguinal hernia repair. [8][9][10][11] However, in laparoscopic inguinal hernia repair, these benefits could not be demonstrated and lack of consensus exists regarding the best mesh for these procedures. 12 In addition, increased risk of recurrence is still a concern with the use of lightweight mesh used in laparoscopic repair.…”