Abstract
Background
Position of the mesh and the method of fixation are important in the occurrence of chronic pain in inguinal herniorrhaphy. An RCT was conducted to evaluate chronic pain after transinguinal preperitoneal (TIPP) repair compared with a Lichtenstein-like repair with a semi-resorbable self-fixing mesh (ProGrip).
Methods
Patients with a primary unilateral inguinal hernia were randomized either to the TIPP (PolySoft mesh) or to repair with a ProGrip mesh. Primary objective was the occurrence of chronic pain after surgery. Secondary objectives were, i.e., recurrences, complications, and quality of life. Follow-up occurred after 2 weeks, 3 months, and 1 year. Patients and physicians were blinded.
Results
Two hundred and fifty-eight patients were randomized to TIPP or ProGrip mesh repair. Two hundred and thirty-eight were included in the analysis: 122 in the TIPP group and 116 in the ProGrip group. Baseline characteristics were compatible. After 2 weeks and 3 months, there was significantly more moderate and severe pain in the ProGrip group on different pain scores. Median pain scores were very low in both groups after 3 months and 1 year (0–0.5 on a scale of 0–10). There was no difference in pain scores between both groups after 1 year. Recurrence rates were low; three patients in each group (2.6 % ProGrip and 2.5 % TIPP).
Conclusion
There was no significant difference in chronic pain between the inguinal repairs with the use of a ProGrip mesh compared with a TIPP repair at 1 year after surgery. In both groups, the occurrence of chronic pain was low.
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References
Statline. http://statline.cbs.nl/StatWeb/publication/?VW=T&DM=SLNL&PA=80386NED&LA=NL. Centraal Bureau voor de Statistiek
Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 4:CD002197
EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235:322–332
Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7
Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89:1310–1314
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126
Amid PK (2004) Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia 8:343–349
Amid PK (2004) Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. Arch Surg 139:1297–1298
Loos MJ, Roumen RM, Scheltinga MR (2007) Classifying post-herniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg 31:1760–1765 (discussion 1766–1767)
O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers B, Horeyseck G (2005) Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg 92:166–170
Post S, Weiss B, Willer M, Neufang T, Lorenz D (2004) Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair. Br J Surg 91:44–48
Kingsnorth A, Gingell-Littlejohn M, Nienhuijs S, Schule S, Appel P, Ziprin P et al (2012) Randomized controlled multicenter international clinical trial of self-gripping Parietex ProGrip polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months. Hernia 16:287–294
Koning GG, Keus F, Koeslag L, Cheung CL, Avci M, van Laarhoven CJ et al (2012) Randomized clinical trial of chronic pain after the transinguinal preperitoneal technique compared with Lichtenstein’s method for inguinal hernia repair. Br J Surg 99:1365–1373
Chastan P (2006) Tension free open inguinal hernia repair using an innovative self gripping semi-resorbable mesh. J Minim Access Surg 2:139–143
Pelissier EP (2006) Inguinal hernia: preperitoneal placement of a memory-ring patch by anterior approach. Preliminary experience. Hernia 10:248–252
Pelissier EP, Monek O, Blum D, Ngo P (2007) The Polysoft patch: prospective evaluation of feasibility, postoperative pain and recovery. Hernia 11:229–234
McCarthy M Jr, Chang CH, Pickard AS, Giobbie-Hurder A, Price DD, Jonasson O et al (2005) Visual analog scales for assessing surgical pain. J Am Coll Surg 201:245–252
Herr KA, Spratt K, Mobily PR, Richardson G (2004) Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain 20:207–219
Loos MJ, Houterman S, Scheltinga MR, Roumen RM (2008) Evaluating postherniorrhaphy groin pain: visual analogue or verbal rating scale? Hernia 12:147–151
Bennett M (2001) The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92:147–157
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403
Berrevoet F, Sommeling C, De Gendt S, Breusegem C, de Hemptinne B (2009) The preperitoneal memory-ring patch for inguinal hernia: a prospective multicentric feasibility study. Hernia 13:243–249
Pelissier EP, Blum D, Ngo P, Monek O (2008) Transinguinal preperitoneal repair with the Polysoft patch: prospective evaluation of recurrence and chronic pain. Hernia 12:51–56
McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114
McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev CD001785
Hallen M, Bergenfelz A, Westerdahl J (2008) Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Surgery 143:313–317
Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89:1476–1479
Lau H, Patil NG, Yuen WK, Lee F (2003) Prevalence and severity of chronic groin pain after endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 17:1620–1623
Sayad P, Hallak A, Ferzli G (1998) Laparoscopic herniorrhaphy: review of complications and recurrence. J Laparoendosc Adv Surg Tech A 8:3–10
Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:188–199
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DC declares no conflict of interest. JPvD declares no conflict of interest. RMHGM declares no conflict of interest.
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All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.
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Informed consent was obtained from all individual participants included in the study.
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Čadanová, D., van Dijk, J.P. & Mollen, R.M.H.G. The transinguinal preperitoneal technique (TIPP) in inguinal hernia repair does not cause less chronic pain in relation to the ProGrip technique: a prospective double-blind randomized clinical trial comparing the TIPP technique, using the PolySoft mesh, with the ProGrip self-fixing semi-resorbable mesh. Hernia 21, 17–27 (2017). https://doi.org/10.1007/s10029-016-1522-6
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DOI: https://doi.org/10.1007/s10029-016-1522-6