Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair

Uzzaman, Mohammed Mohsin; Ratnasingham, Kumaran; Ashraf, Nadeem

doi:10.1007/s10029-012-0901-x

Cited by 54 publications

(37 citation statements)

References 41 publications

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“…In open groin hernia surgery, several meta-analyses of randomised trials have now shown that lightweight (flat) meshes do not have an advantage in the short-term, but are associated with less chronic (C6 months) pain and foreign body feeling [18,19], although the incidence of severe chronic groin pain is not decreased [20]. Importantly, this does not increase the recurrence rate at one year (range 6-60 months), although caution is still needed in large (direct) hernias with a potential increased risk for mesh migration into the defect, especially when some specific points for mesh fixation are not taken into account [21][22][23].…”

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

359

226

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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

359

226

View full text Add to dashboard Cite

show abstract

“…At present, tension-free preshaped mesh hernioplasties have become a gold standard for most operating surgeons and over the last decade several types of meshes have evolved, and are used as single flat meshes or used in conjunction with three dimensional plugs. [9][10][11] In 1984, Lichtenstein addressed the issue of tension by popularizing routine use of mesh (monofilament polypropyelene meshes) which was laid on posterior wall of the inguinal canal, and a slit made at the lateral end of the mesh, creating two tails, which pass around the cord as it emerges from the internal ring. Presently newer mesh concepts are the current interest which has less chronic pain, earlier return to normal activities without compromising on recurrence.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of postoperative complications of lightweight mesh and conventional prolene mesh in Lichtenstein hernia repair

2016

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“…A number of studies have compared heavyweight with lightweight meshes in open anterior hernia repair and revealed a significant reduction in foreign body feeling and overall post-operative pain [11][12][13][14]. Lightweight meshes are, therefore, recommended as the material of choice in primary open inguinal hernioplasty [15].…”

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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Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair

Abstract: The use of lightweight mesh in Lichtenstein inguinal hernia repair is associated with less chronic pain, and foreign body sensation compared with heavyweight mesh without any difference in recurrence.

Cited by 54 publications

References 41 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

A comparative study of postoperative complications of lightweight mesh and conventional prolene mesh in Lichtenstein hernia repair

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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