Lower recurrence rate with heavyweight mesh compared to lightweight mesh in laparoscopic totally extra-peritoneal (TEP) repair of groin hernia: a nationwide population-based register study

Abstract

PurposeLightweight meshes (LWM) have shown benefits compared to heavyweight meshes (HWM) in terms of less postoperative pain and stiffness in open inguinal hernia repair. It appears to have similar advantages also in TEP, but concerns exist if it may be associated with higher recurrence rates. The aim of the study was to compare reoperation rate for recurrence of LWM to HWM in laparoscopic totally extra-peritoneal (TEP) repair.MethodsAll groin hernias operated on with TEP between 1 January 2005 and 31 December 2013 at surgical units participating in The Swedish Hernia Register were eligible. Data included clinically important hernia variables. Primary endpoint was reoperation for recurrence. Median follow-up time was 6.1 years (0–11.5) with minimum 2.5 years postoperatively.ResultsIn total, 13,839 repairs were included for statistical analysis and 491 were re-operated for recurrence. Multivariate analysis demonstrated significantly increased risk of reoperation for recurrence in LWM 4.0% (HR 1.56, P < 0.001) compared to HWM 3.2%. This was most evident in direct hernias (HR 1.75, P < 0.001) and in hernia repairs with a defect > 3 cm (HR 1.54, P < 0.021). The risk of recurrence with use of LWM in indirect hernias and in hernia repairs with a defect < 1.5 cm was more comparable to HWM.ConclusionsLightweight meshes were associated with an increased risk of reoperation for recurrence compared to HWM. While direct hernias and larger hernia defects may benefit from HWM to avoid increased recurrence rates, LWM is recommended to be used in indirect and smaller hernia defects in TEP repair.

TEP for elective primary unilateral inguinal hernia repair in men: what do we know?

“…The findings of that large RCT were then confirmed once again by an analysis of data from the Swedish Hernia Registry [85]. That registry analysis of data on 13,839 TEP repairs identified a significantly higher recurrence rate for lightweight meshes (4.0% vs 3.2%; p < 0.001) [85].…”

“…Surprisingly, comparison of lightweight vs heavyweight meshes for elective primary unilateral inguinal hernia repair in men demonstrated an advantage for the heavyweight meshes in terms of a lower recurrence rate [75][76][77][78][79][80][81][82][83][84][85], with no attendant increase in the chronic pain rate.…”

“…That registry analysis of data on 13,839 TEP repairs identified a significantly higher recurrence rate for lightweight meshes (4.0% vs 3.2%; p < 0.001) [85]. The difference persisted even after exclusion of bilateral inguinal hernias and recurrences [85].…”

Preparation and Performances of Warp-Knitted Hernia Repair Mesh Fabricated with Chitosan Fiber

“…All three kinds of fabrics belong to lightweight mesh with little difference in thickness. Lightweight mesh has many advantages [21,22,23]. Porosity reflects the size and pore distribution of the mesh, which is one of the important indexes to evaluate whether or not the mesh meets clinical specifications [24,25].…”

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

“…12 In addition, increased risk of recurrence is still a concern with the use of lightweight mesh used in laparoscopic repair. 13 The aim of this study was to compare the outcomes of lightweight versus heavyweight mesh in laparoscopic total extraperitoneal (TEP) inguinal hernia repair with respect to recurrence, chronic pain, foreign body sensation, and seroma in published randomized controlled trials.…”