Heavyweight Mesh Is Superior to Lightweight Mesh in Laparo-endoscopic Inguinal Hernia Repair

Bakker, Wouter J; Aufenacker, Theo; Boschman, Julitta S.; Burgmans, J. P. J.

doi:10.1097/sla.0000000000003831

Cited by 31 publications

(20 citation statements)

References 42 publications

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“…Perhaps more relevant is the collective experience of clinical trials that compare mesh weights for laparoscopic inguinal hernia repair because this mesh is similarly placed in the retromuscular position. Although lightweight mesh has demonstrated limitations in regard to durability for such repairs, these trials have likewise found no difference between rates of pain and foreign-body sensation. Finally, 2 randomized clinical trials comparing mesh weight in open ventral hernia repair likewise found no patient-perceived benefits to the lightweight material.…”

Section: Discussionmentioning

confidence: 99%

Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

et al. 2021

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IMPORTANCEAlthough multiple versions of polypropylene mesh devices are currently available on the market for hernia repair, few comparisons exist to guide surgeons as to which device may be preferable for certain indications. Mesh density is believed to impact patient outcomes, including rates of chronic pain and perception of mesh in the abdominal wall.OBJECTIVE To examine whether medium-weight polypropylene is associated with less pain at 1 year compared with heavy-weight mesh. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial was performed from March 14, 2017, to April 17, 2019, with 1-year follow-up. Patients undergoing clean, open ventral hernia repairs with a width 20 cm or less were studied. Patients were blinded to the intervention. INTERVENTIONS Patients were randomized to receive medium-weight or heavy-weight polypropylene mesh during open ventral hernia repair. MAIN OUTCOMES AND MEASURES The primary outcome was pain measured with the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a. Secondary outcomes included quality of life and pain measured at 30 days, quality of life measured at 1 year, 30-day postoperative morbidity, and 1-year hernia recurrence. RESULTS A total of 350 patients participated in the study, with 173 randomized to receive heavy-weight polypropylene mesh (84 [48.6%] female; mean [SD] age, 59.2 [11.4] years) and 177 randomized to receive medium-weight polypropylene mesh (91 [51.4%] female; mean [SD] age, 59.3 [11.4] years). No significant differences were found in demographic characteristics (mean [SD] body mass index of 32.0 [5.4] in both groups [calculated as weight in kilograms divided by height in meters squared] and American Society of Anesthesiologists classes of 2-4 in both groups), comorbidities (122 [70.5%] vs 93 [52.5%] with hypertension, 44 [25.4%] vs 43 [24.3%] with diabetes, 17 [9.8%] vs 12 [6.8%] with chronic obstructive pulmonary disease), or operative characteristics (modified hernia grade of 2 in 130 [75.1] vs 140 [79.1] in the heavy-weight vs medium-weight mesh groups). Pain scores for patients in the heavy-weight vs medium-weight mesh groups at 30 days (46.3 vs 46.3, P = .89) and 1 year (30.7 vs 30.7, P = .59) were identical. No significant differences in quality of life (median [interquartile range] hernia-specific quality of life score at 1 year of 90.0 [67.9-96.7] vs 86.7 [65.0-93.3]; median [interquartile range] hernia-specific quality of life score at 30 days, 45.0 [24.6-73.8] vs 43.3 [28.3-65.0]) were found for the heavy-weight mesh vs medium-weight mesh groups. Composite 1-year recurrence rates for patients in the heavy-weight vs medium-weight polypropylene groups were similar (8% vs 7%, P = .79).CONCLUSIONS AND RELEVANCE Medium-weight polypropylene did not demonstrate any patient-perceived or clinical benefit over heavy-weight polypropylene after open retromuscular ventral hernia repair. Long-term follow-up of these comparable groups will elucidate a...

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Section: Discussionmentioning

confidence: 99%

Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

et al. 2021

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“…The authors affirmed that the peritoneal incision and closure with continuous suture may be responsible for high pain scores for TAPP repair. However, not only the peritoneal incision is determinant of postoperative pain, but also several factors including patients' subjective pain perception and expression, different protocols for anesthesia, postoperative analgesia, methods for mesh fixation (tacks vs. glue vs. self-gripping), mesh type, and weight (g/m 2 ) have been shown to be additional causes of postoperative pain [56][57][58][59]. While our results seem to support equivalent Surgeon experience, expertise, variation in technical skills, and hospital volume are key determinants for operative time while TAPP and TEP have been shown to be associated with a steep learning curve [60,61].…”

Section: Discussionmentioning

confidence: 99%

Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials

Aiolfi

Cavalli

Ferraro

et al. 2021

Hernia

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Purpose To examine the updated evidence on safety, effectiveness, and outcomes of the totally extraperitoneal (TEP) versus the laparoscopic transabdominal preperitoneal (TAPP) repair and to explore the timely tendency variations favoring one treatment over another. Methods Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were consulted. Risk Ratio (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used as pooled effect size measures. Results Fifteen RCTs were included (1359 patients). Of these, 702 (51.6%) underwent TAPP and 657 (48.4%) TEP repair. The age of the patients ranged from 18 to 92 years and 87.9% were males. The estimated pooled RR for hernia recurrence (RR = 0.83; 95% CI 0.35–1.96) and chronic pain (RR = 1.51; 95% CI 0.54–4.22) were similar for TEP vs. TAPP. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus supporting true negative results while the information size was calculated as adequate for both outcomes. No significant differences were found in term of early postoperative pain, operative time, wound-related complications, hospital length of stay, return to work/daily activities, and costs. Conclusions TEP and TAPP repair seems comparable in terms of postoperative hernia recurrence and chronic pain. The cumulative evidence and information size are sufficient to provide a conclusive evidence on recurrence and chronic pain. Similar trials or meta-analyses seem unlikely to show diverse results and should be discouraged.

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“…A trend is slowly emerging in the literature to use heavier implants in the case of large and complex inguinal defects treated with laparoendoscopic techniques. Some studies point to the superiority of heavier implants in the context of recurrence, especially when routine xation is not used (14,15).…”

Section: Discussionmentioning

confidence: 99%

MEsh FIxation in Laparoendsocopic Repair of Large M3 Inguinal Hernias - Multicenter, Double-blinded, Randomized Controlled Trial – study protocol for a MEFI Trial

Zamkowski¹,

Śmietański²

2023

Preprint

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• Background Guidelines of groin hernia treatment strongly recommends to fixate the mesh in large M3 medial defects during TAPP / TEP procedures. Main purpose of fixation is to decrease recurrence rate which is alarmingly high in case of those defects. In 2022 team consisting of hernia surgeons and scientists from universities of technology conducted an experimental study with the use of 3d groin model to verify the hypothesis that fixation is not necessary in above cases. Experiment showed that rigid and anatomically shaped meshes are able to maintain its position in groin without fixation. Similar conclusions were recently published in Swedish database registry analysis. To confirm above results we decided to conduct multicenter randomized controlled trial.. • Methods Main objective of MEFI Trial is to verify the hypothesis that non-fixation of spatial, standard polypropylene meshes is non-inferior to fixation of flat, polypropylene lightweight meshes in M3 hernias by laparoendoscopic approach. 11 large surgery centers in Poland having proficiency in laparoendoscopic groin hernia repairs were recruited for this study. Recurrence in 12-month follow-up was set as a primary endpoint. Pain sensation (Visual Analog Scale) and incidence of other complications (hematoma, seroma, SSI) were also noted. Based on the statistical analysis, minimal sample size in both arms was established at 83–102. First arm (control) consists of patients undergoing a repair with the use of flat, macroporous mesh with fixation using histoacryl glue. In second arm patients will be operated with the use of anatomically shaped, standard-weight mesh without fixation. Study will be double-blinded (patient/surgeon). After dissection of preperitoneal space, surgeon will open sealed envelope and find out which technique he will have to perform. Follow-up will be performed by Study Secretary (also blinded to method used) via phone call 3 and 12-months after surgery.. • Discussion Based on experimental study and recent registry analysis, we believe that recurrence rate in both groups would be on the same level, giving hernia societies strong argument for amending the guidelines.. Trial registration ClinicalTrials.gov Identifier: NCT05678465 registered on January 10, 2023

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Heavyweight Mesh Is Superior to Lightweight Mesh in Laparo-endoscopic Inguinal Hernia Repair

Cited by 31 publications

References 42 publications

Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair

Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials

MEsh FIxation in Laparoendsocopic Repair of Large M3 Inguinal Hernias - Multicenter, Double-blinded, Randomized Controlled Trial – study protocol for a MEFI Trial

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