Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair

Post, Stefan; Weiss, B; Willer, M.; Neufang, T.; Lorenz, D.

doi:10.1002/bjs.4387

Cited by 185 publications

(147 citation statements)

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“…The incidence of perioperarive and postoperative complications is minimal. 8 Most of the patients return to routine life within 48 hours and 60% of physical laborers return to work within 4 weeks. Yet there is a high incidence of chronic groin pain following hernia repair.…”

Section: Discussionmentioning

confidence: 99%

“…7 Lichtenstein technique has since become the most commonly performed surgery for inguinal hernia and because it provides a tension-free repair with good long-term results. 8,9 Tension-free mesh repair is nevertheless associated with complications such as foreign body reaction, infection, pain, fistula formation, migration, shrinkage, and recurrence. 10 Other complications include skin anaesthesia, bruising and haematoma formation, seroma formation, orchitis and testicular atrophy.…”

Section: Introductionmentioning

confidence: 99%

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Desarda’s versus Lichtenstein technique of inguinal hernia repair

Obaid¹

2017

Int Surg J

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INTRODUCTIONInguinal hernia is one of the most common diseases manage by surgeon.1 A hernia is abnormal protrusion of a viscus or a part of viscus through an opening in the wall of cavity containing it. It tends to occur at natural areas of weakness, where muscles are not strong and are vulnerable to intra-abdominal pressure. The estimated lifetime risk for inguinal hernia is 27% for men and 3% for women. 2The choice of a surgery depends on the surgeon as there were no written surgical guidelines for hernia treatment till 2009. [3][4][5] There is a considerable variation in the efficiency of all these procedures which is calculated by the rate of recurrence, complications which is also influenced not only by the different techniques but also by experience and the technical skills of the surgeons. 6 However, the ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent ABSTRACT Background: Ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent achieves this entire goal. The Lichtenstein mesh repair is associated with complications, postoperative dysfunction and high cost composite meshes. Desarda's technique, became a new surgical option for tissue-based inguinal hernia repair. The present study was designed to evaluate and compare the effectiveness and complications of the Desarda's repair with Lichtenstein tension-free mesh repair for treatment of inguinal hernia in a developing country. Methods: 200 patients with unilateral, primary, reducible inguinal hernia were selected. Included patients were randomly divided into two groups. Studied parameters were Duration of surgery, intra operative complications, postoperative Pain, Duration of hospital stay, return to normal activities, post-operative complications and recurrences. Results: There were a total of 100 patients each group. There was no statistically significant difference in duration of surgery and complication rate between the two groups. Difference in mean VAS was not statistically significant. The mean hospital stay in Desarda's technique was 2.5 days while it was 2.6 days in Lichtenstein's group. The mean time to return to basic physical activity in the Desarda's technique was 12.6 days while it was 13.3 days in the Lichtenstein's group. There were no recurrences in either group. Chronic inguinal pain (>1month) was more frequent in Lichtenstein's group. Conclusions: There is no significant difference in duration of surgery, intra operative complication rate, postoperative pain, complications and recurrence, between Desarda's technique and Lichtenstein's technique. However chronic inguinal pain is less in Desarda's technique. Desarda's repair must be considered in young patients (<30 years). Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Obaid¹

2017

Int Surg J

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“…In addition, the structure of the mesh is an important factor in the development of postoperative pain, and use of synthetic non-absorbable flat mesh or composite mesh is recommended because these cause less pain (11). Post et al (13) reported that the pain might be caused by the weight and composition of the mesh, and that the feeling of a foreign body sensation was higher in the heavyweight mesh group. In contrast, Bringman et al (14) found no difference in postoperative pain between lightweight and heavyweight mesh groups.…”

Section: Resultsmentioning

confidence: 99%

Effect of Peritoneal Incision on Immediate Pain After Inguinal Hernia Repair: A Prospective Cohort Study

Tanrıkulu

Cagsar

Yalcin

et al. 2015

International Surgery

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Objective: Hernia repair is a common surgical procedure, and postoperative pain is an inevitable result of hernia surgery. The prevention of postoperative pain is of considerable importance in terms of patient comfort and early discharge. In this study, we evaluated the effects of a peritoneal incision on pain in the early postoperative period.Summary of Background Data: This was a prospective clinical study with 75 patients undergoing inguinal hernia repair. Methods: Patients were divided into five groups: group 1: indirect hernia, Lichtenstein repair with peritoneal incision, group 2: indirect hernia, Lichtenstein repair without peritoneal incision, group 3: all hernias, trans-abdominal preperitoneal(TAPP) repair, group 4: all hernias, total extraperitoneal (TEP) repair, and group 5: direct hernia, Lichtenstein repair with no peritoneal incision. Groups were compared in terms of postoperative pain scores at three different times and complications.Results: There were 62 males and 13 females; their average age was 51.25 years. The visual analog scale (VAS) scores were lower in groups 2, 4, and 5, and there were differences among groups and within each group according to VAS changes assessed at all time points (p < 0.05). There was no difference, according to VAS analysis, between open and laparoscopic surgery groups. There was a difference according to VAS changes in each group between hernia sides (p < 0.001).Conclusion: Peritoneal incision is a significant risk factor for postoperative pain after inguinal hernia repair. But, surgical procedure was not a risk factor although VAS scores were higher in open than laparoscopic surgery.

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“…[4]Lichtenstein presented his open mesh repair technique for inguinal hernia in 1986. [56]Tension-free mesh repair is nevertheless associated with complications such as foreign body reaction, infection, pain, fistula formation, migration, shrinkage, and recurrence. [7]…”

mentioning

confidence: 99%

“…[20]It is now believed that most of these symptoms are related to the type of material used as mesh for the repair rather than the technique employed. [21]In the past decade, with the introduction of mesh repair for groin hernia the incidence of recurrence following the procedure was found lower than 3% in most studies. [22]…”

mentioning

confidence: 99%

Polyglactine/Polypropylene Mesh vs. Propylene Mesh: Is there a need for newer prosthesis in inguinal hernia?

Khan

Bangash

Sadiq

et al. 2010

Saudi J Gastroenterol

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Background/Aim:To compare outcomes of light and heavy weight mesh for repair of inguinal hernia.Materials and Methods:This study was conducted at the Department of Surgery; Lady Reading Hospital, Peshawar from January 1, 2007 to December 31, 2008. Patients were divided into two groups based on the type of mesh implanted for inguinal hernia repair. Group 1 included patients in whom light weight composite (VyproII®) mesh is implanted: Group 2 included patients in whom polypropylene (ProleneR) mesh is implanted. Data concerning the complications and post operative pain in the perioperative and postoperative period were collected and analyzed. Categorical data were presented as percentages with 95% confidence intervals and compared using a χ2test and P<0.05 were considered significant.Results:Following allocation and exclusion of violating cases, 111 patients in group 1 and 138 patients in group 2 were analyzed. The mean age in group 1 was 38.20 ± 13.34 years and in group 2 was 39.55 ± 13.70 (P = 0.434). In group 1, hematoma formation was observed in four cases (3.6%), while it was observed in six cases (4.2%) in group 2 (P = 0.766). During the entire study, ten patients in all developed urinary retention, three of which required transient catheterization. One year post operation, there was a recurrence in only five cases overall, while only two patients complained of pain (P = 0.826).Conclusion:The frequency of postoperative pain and complications in patients was similar in both groups.

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Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair

Abstract: Lightweight polypropylene mesh may be preferable for Lichtenstein repair of inguinal hernia. Larger cohorts with longer follow-up are needed before it can be recommended for routine use.

Cited by 185 publications

References 12 publications

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Desarda’s versus Lichtenstein technique of inguinal hernia repair

Effect of Peritoneal Incision on Immediate Pain After Inguinal Hernia Repair: A Prospective Cohort Study

Polyglactine/Polypropylene Mesh vs. Propylene Mesh: Is there a need for newer prosthesis in inguinal hernia?

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