Early results of a randomised trial comparing Prolene and VyproII-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias

Abstract

The purpose of this study was to compare a lightweight mesh to a standard polypropylene hernia mesh in endoscopic extraperitoneal hernioplasty in recurrent hernias. A total of 140 men with recurrent unilateral inguinal hernias were randomised to a totally extraperitoneal endoscopic hernioplasty (TEP) with Prolene or VyproII in a single-blinded multi-center trial. The randomisation and all data handling were performed through the Internet. 137 patients were operated as allocated. Follow-up was completed in 88% of the patients. The median operation times were 55 (24-125) min and 53.5 (21-123) min for the Prolene and VyproII groups, respectively. The meshes had comparable results in the surgeon's assessment of the handling of the mesh, return to work, return to daily activities, complications, postoperative pain and quality of life during the first 8 weeks of rehabilitation, except in General Health (GH) SF-36, where the VyproII-group had a significantly better score (P=0.045). The use of Prolene and VyproII-meshes in endoscopic repair of recurrent inguinal hernia seems to result in similar short-term outcomes and quality of life.

Inguinal hernia repair: current surgical techniques

“…One meta-analysis [68] and 17 RCTs have been published comparing heavyweight meshes to lightweight meshes, with nine of the studies using open surgery [69][70][71][72][73][74][75][76][77] and eight using laparoscopic repair [78][79][80][81][82][83][84][85]. The results were controversial and limited; only four of the laparoscopic surgery studies [82][83][84][85] had a follow-up longer than 3 months.…”

“…Over the short term, lightweight meshes have advantages with regard to physical fitness [80,84,85], daily activities [78], and general health and bodily pain [79], and in one study with regard to pain [81]. One study using a titanized extra-light (16 g/m²) polypropylene mesh found significantly less seroma production when compared to a classic heavyweight (90 g/m²) mesh [84].…”

Comparison of a lightweight polypropylene mesh (Optilene® LP) and a large-pore knitted PTFE mesh (GORE® INFINIT® mesh)—Biocompatibility in a standardized endoscopic extraperitoneal hernia model

“…This improved biocompatibility is also reflected in clinical routine by a clearly reduced morbidity rate among patients in shortand long-term progression. In the mean time, numerous studies have demonstrated improved patient comfort with less postoperative pain, lower seroma formation and quicker convalescence [13][14][15][16][17][18][19][20][21]. These results are also independent of the surgical access route used.…”

Three-month results of the effect of Ultrapro or Prolene mesh on post-operative pain and well-being following endoscopic totally extraperitoneal hernia repair (TULP trial)

“…Thus, these data probably underestimate the true frequency. Other studies with small sample sizes used mean VAS scores to compare differences [9,19,37]. As the majority of patients report very low VAS scores, the mean VAS scores were very low.…”

“…In a recent metaanalysis of eight randomized controlled trials comparing lightweight versus heavyweight mesh in laparoscopic hernia repair [16], the benefit of lightweight meshes was not reproduced, although the quality of several studies was hampered by small sample size [8,17,18] or missing data regarding the endpoint of interest, i.e. chronic pain after 3 months [9,19]. Two large RCT's showed a slight improvement in patient comfort and less foreign body feeling after lightweight mesh [20,21].…”