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

Xu, Ming; Xu, Shumin

doi:10.1177/000313481908500626

Cited by 10 publications

(1 citation statement)

References 30 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%