A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia

Abstract

Background

Chronic pain may be a long-term problem related to operative trauma and mesh material in Lichtenstein hernioplasty.

Study design

Inguinal hernioplasty was performed under local anesthesia in 228 patients (232 hernias) in day-case surgery by the same surgeon and exactly by the same surgical technique. The patients were randomized to receive either a partly absorbable polypropylene–polyglactin mesh (Vypro II^R 50 g/m², 79 hernias), a lightweight polypropylene mesh (Premilene Mesh LP^R 55 g/m², 75 hernias) or a conventional densely woven polypropylene mesh (Premilene^R 82 g/m², 78 hernias). Pain, patients discomfort and recurrences of hernias were carefully followed at days 1, 7, 1 month, 1 and 2 years after surgery.

Results

The duration of operation (29–33 min) and the amount of local anesthetic (55–57 ml) were similar in the three groups. Two wound infections and four hematomas were detected with no difference between the meshes. Immediate pain reaction up to 1 month was statistically equal among the three meshes. After 2 years of follow-up, there were five recurrences (two in the Vypro group, one in the Premilene LP and two in the Premilene). A feeling of a foreign body, sensation of pain and patient’s discomfort were similar with all meshes.

Conclusion

There was no difference of pain and quality of life among a conventional polypropylene mesh, lightweight mesh or partly absorbable mesh in 2 years of follow-up, when the same surgeon operated on all patients with exactly the same technique.