Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis

Currie, Andrew; Andrew, Helen; Tonsi, Alfredo; Hurley, Paul R.; Taribagil, Sanjay

doi:10.1007/s00464-012-2179-6

Cited by 72 publications

(48 citation statements)

References 28 publications

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“…There is no sufficient evidence for such recommendation in endoscopic groin hernia repair, as recently shown in a meta-analysis of eight RCTs (6 TEP, 2 TAPP) with a mean follow-up of 2-60 months [27], both with respect to shortor long-term outcome. Only one study by Bittner et al [28] concerning small hernias (B3 cm), not included in the meta-analysis, showed some minor benefits with an ''extralight'' mesh (less analgesics, less impairment in physical activities).…”

Section: Materials Reduced (Or Lightweight Large Pore) Meshesmentioning

confidence: 99%

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Miserez

Peeters

Aufenacker

et al. 2014

Hernia

337

225

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Purpose: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence. Methods: The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members. Results: For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold). Conclusions: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015

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Section: Materials Reduced (Or Lightweight Large Pore) Meshesmentioning

confidence: 99%

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Miserez

Peeters

Aufenacker

et al. 2014

Hernia

337

225

View full text Add to dashboard Cite

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“…Biomechanical properties such as weight, surface area, pore size and the structure of the mesh combined with its chemical properties, seem to influence the risk of meshrelated post-operative complications of shrinkage, migration, infection and nerve damage (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Tapp Inguinal Hernia Repair: Mesh Fixation With Absorbable Tacks, Initial Experience

Agresta

Marzetti

Verza

et al. 2016

J Minim Invasive Surg Sci

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Background: Preliminary studies have indicated advantages of mesh fixation using fibrin glue in TAPP compared with tack fixation. Objectives: We report the results of a prospective experience in fixing mesh during TAPP with absorbable tacks. Patients and Methods: 50 consecutive men (who had bilateral inguinal hernia) were enrolled and followed up for at least 1 year. The primary measured outcome was pain experienced in day 1 of post-op. The secondary outcomes measured were postoperative scores of pain at rest, discomfort, and fatigue, foreign-body sensation, and hernia recurrence after 12 months. The outcomes were measured using a visual analogue scale, a verbal rating scale and numerical rating scales. A comparison was done within a historical group with the same demographic and hernia characteristics where the meshes have been fixed with fibrin glue. Results: The group of tacks 'TAPP' showed good results concerning the level of pain, fatigue and foreign body sensation comparable with those of the historical group. There were significant differences concerning the length of surgery where absorbable tacks performed better. Regarding cost of surgery, the fibrin glue showed effective results. Conclusions: The use of absorbable tacks during TAPP confers significant benefit regarding the operating time, however it is a disadvantage due to the cost when compared with fibrin glue.

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“…Other studies reporting on mesh types in endoscopic repair showed absent or slight differences in comfort [16]. Then again, in open repair, evidence is available that lightweight meshes provide better results.…”

Section: Discussionmentioning

confidence: 96%

“…Lightweight meshes are, therefore, recommended as the material of choice in primary open inguinal hernioplasty [15]. 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].…”

mentioning

confidence: 99%

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)

et al. 2015

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Background Recurrence rates after inguinal hernia repair have been reduced to a few per cent, since mesh repair has become standard of care. Lightweight meshes reduce postoperative pain and stiffness in open anterior repair, but for endoscopic repair, the discussion about this benefit is ongoing. This study was done to analyse the effects of lightweight mesh versus heavyweight mesh following endoscopic totally extraperitoneal (TEP) hernia repair. Methods In a single-centre double-blindly randomized clinical trial, 950 patients with unilateral primary inguinal hernia were randomized to undergo endoscopic TEP using either an Ultrapro Ò or a Prolene Ò mesh. Data were collected by validated questionnaires at day 1, day 7, after 6 weeks and after 3 months, and clinical assessment was performed after 3 months. The presence of groin pain after 3 months, defined as an NRS score [3, was evaluated as the primary outcome measure. Secondary outcomes were foreign body feeling and the impact of pain and foreign body feeling on daily activities.Results At 3-month follow-up, the incidence of pain (NRS 4-10) was 2 versus 0.9 % in the lightweight and heavyweight mesh group, respectively (p = 0.17). Pain interfered with daily activities in 1.7 % of the lightweight and 1.5 % of heavyweight group. In the lightweight group, 20 % of patients reported a foreign body feeling versus 18 % in the heavyweight group (p = 0.62). No differences between the groups were observed regarding time to return to work, interference with sports and sexual activities, testicular pain and ejaculatory pain. Severe preoperative pain (OR 2.01, 95 % CI 1.21-3.35, p = 0.01) was the only independent predictor of any post-operative pain after 3 months. Conclusion Three months after TEP inguinal repair, there were no significant differences between lightweight and heavyweight mesh use regarding the incidence of pain, foreign body feeling or any other endpoint.

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Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis

Abstract: Both mesh options appear to result in similar long- and short-term postoperative outcomes. Further long-term analysis may guide surgeon selection of mesh weight for laparoscopic inguinal hernia repair.

Cited by 72 publications

References 28 publications

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Laparoscopic Tapp Inguinal Hernia Repair: Mesh Fixation With Absorbable Tacks, Initial Experience

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)

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