Advertisement

Hernia

pp 1–6 | Cite as

Prolene hernia system versus Lichtenstein repair for inguinal hernia: a meta-analysis

  • E. DeckerEmail author
  • A. Currie
  • M. K. Baig
Review
  • 143 Downloads
Part of the following topical collections:
  1. Forum on primary monolateral uncomplicated inguinal hernia

Abstract

Background

Lichtenstein repair is standard practice for inguinal herniorrhaphy, but there is increasing public concern in the use of mesh and postoperative chronic pain. New mesh technology, such as the prolene hernia system, has a preperitoneal component to reinforce the myopectineal orifice aim to reduce the risk of recurrence and chronic pain. This meta-analysis compares outcomes using prolene hernia system versus lichenstein repair for inguinal hernias.

Methods

Randomized-controlled trials comparing prolene hernia system and Lichtenstein repair were identified using Embase, Medline, and published conference abstracts. Primary outcomes were recurrence and chronic pain. Secondary outcomes were mean operating time, composite complications, surgical reintervention, and time to normal activities. Odds ration and standardized mean differences were calculated.

Results

1377 hernia repairs were identified from a total of 7 trials. Mean follow-up was 12–91 months. There was no difference between the techniques for recurrence [pooled analysis odds ratio: 0.86 (95% CI 0.32–2.28); p = 0.76] and chronic pain [pooled analysis odds ratio: 1.00 (95% CIs 0.65–1.55); p = 1]. Prolene hernia system demonstrated a shorter time to return to normal activities [pooled weighted mean difference − 0.54 (95% CI − 1.07 to − 0.01); p = 0.04]. Other outcomes were similar in mean operating time, composite complications, and surgical reintervention.

Conclusion

Both prolene hernia system and Lichenstein repair appear comparable acceptable techniques for inguinal herniorrhaphy. Further longer-term studies of new mesh technologies will improve information available to surgeons and their patients.

Keywords

Meta-analysis Lichtenstein Prolene hernia system Recurrence Long-term follow-up 

Notes

Acknowledgements

The authors would like to thank Drs. Magnusson and Kingsnorth for providing further information and data for inclusion in this meta-analysis.

Compliance with ethical standards

Conflict of interest

The authors have neither conflict of interest nor funding for this meta-analysis.

Ethical approval

This was deemed to not be required.

Human and animal rights

This article does not contain any direct involvement of human participants as it is comprised of data from papers already published.

Informed consent

Informed consent was not necessary for this study

References

  1. 1.
    Lichtenstein IL, Shulman AG (1986) Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg 71(1):1–4Google Scholar
  2. 2.
    Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen TJ (2006) Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg 93(9):1056–1059CrossRefGoogle Scholar
  3. 3.
    Beitler JC, Gomes SM, Coelho AC, Manso JE (2009) Complex inguinal hernia repairs. Hernia J Hernias Abdom Wall Surg 13(1):61–66CrossRefGoogle Scholar
  4. 4.
    Lundstrom KJ, Sandblom G, Smedberg S, Nordin P (2012) Risk factors for complications in groin hernia surgery: a national register study. Ann Surg 255(4):784–788CrossRefGoogle Scholar
  5. 5.
    Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J et al (2010) Predictive risk factors for persistent postherniotomy pain. Anesthesiology 112(4):957–969CrossRefGoogle Scholar
  6. 6.
    Nienhuijs SW, Boelens OB, Strobbe LJ (2005) Pain after anterior mesh hernia repair. J Am Coll Surg 200(6):885–889CrossRefGoogle Scholar
  7. 7.
    Hakeem A, Shanmugam V (2011) Inguinodynia following Lichtenstein tension-free hernia repair: a review. World J Gastroenterol 17(14):1791–1796CrossRefGoogle Scholar
  8. 8.
    Lundstrom KJ, Holmberg H, Montgomery A, Nordin P (2018) Patient-reported rates of chronic pain and recurrence after groin hernia repair. Br J Surg 105(1):106–112CrossRefGoogle Scholar
  9. 9.
    Olsson A, Sandblom G, Franneby U, Sonden A, Gunnarsson U, Dahlstrand U (2017) Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair. Surgery 161(2):509–516CrossRefGoogle Scholar
  10. 10.
    Kurzer M, Kark AE, Belsham PA (2005) Open preperitoneal mesh repair for recurrent inguinal hernias. Hernia J Hernias Abdom Wall Surg 9(1):105CrossRefGoogle Scholar
  11. 11.
    Gilbert AI, Graham MF, Voigt WJ (1999) A bilayer patch device for inguinal hernia repair. Hernia J Hernias Abdom Wall Surg 3(3):161–166CrossRefGoogle Scholar
  12. 12.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRefGoogle Scholar
  13. 13.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558CrossRefGoogle Scholar
  14. 14.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12CrossRefGoogle Scholar
  15. 15.
    Pierides G, Vironen J (2011) A prospective randomized clinical trial comparing the Prolene Hernia System and the Lichtenstein patch technique for inguinal hernia repair in longterm: 2- and 5-Year results. Am J Surg 202(2):188–93CrossRefGoogle Scholar
  16. 16.
    Dalenback J, Andersson C, Anesten B (2009) Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. The BOOP study: bi-layer and connector, on-lay, and on-lay with plug for inguinal hernia repair. Hernia 13(2):121–129.CrossRefGoogle Scholar
  17. 17.
    Magnusson J, Nygren J, Gustafsson UO, Thorell A (2016) UltraPro Hernia System, Prolene Hernia System and Lichtenstein for primary inguinal hernia repair: 3-year outcomes of a prospective randomized controlled trial. Hernia 20(5):641–648CrossRefGoogle Scholar
  18. 18.
    Sanjay P, Harris D, Jones P (2006) Randomized controlled trial comparing prolene hernia system and lichtenstein method for inguinal hernia repair. ANZ J Surg 76(7):548–52CrossRefGoogle Scholar
  19. 19.
    Nienhuijs SW, Rosman C (2015) Long-term outcome after randomizing prolene hernia system, mesh plug repair and Lichtenstein for inguinal hernia repair. Hernia 19(1):77–81CrossRefGoogle Scholar
  20. 20.
    Kingsnorth AN, Wright D, Porter CS (2002) Prolene Hernia System compared with Lichtenstein patch: a randomised double blind study of short-term and medium-term outcomes in primary inguinal hernia repair. Hernia 6(3):113–119CrossRefGoogle Scholar
  21. 21.
    Badjur N, Garg N (2015) Comparative Study of Prolene Hernia System and Lichtenstein Method for Open Inguinal Hernia Repair. J Clin Diagn Res 9(6):PC04–PC07Google Scholar
  22. 22.
    Currie A, Andrew H, Tonsi A, Hurley PR, Taribagil S (2012) Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis. Surg Endosc 26(8):2126–2133CrossRefGoogle Scholar
  23. 23.
    Sajid MS, Leaver C, Baig MK, Sains P (2012) Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg 99(1):29–37CrossRefGoogle Scholar
  24. 24.
    Stoppa R, Petit J, Abourachid H, Henry X, Duclaye C, Monchaux G et al (1973) Original procedure of groin hernia repair: interposition without fixation of Dacron tulle prosthesis by subperitoneal median approach. Chirurgie; memoires de l’Academie de chirurgie 99(2):119–123Google Scholar
  25. 25.
    Kugel RD (1999) Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless, inguinal herniorrhaphy. Am J Surg 178(4):298–302CrossRefGoogle Scholar
  26. 26.
    Ugahary F (2001) The gridiron hernioplasty. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH (eds) Hernias of the abdominal wall: principles and management. Springer, New York, p 407CrossRefGoogle Scholar
  27. 27.
    Willaert W, De Bacquer D, Rogiers X, Troisi R, Berrevoet F (2012) Open preperitoneal techniques versus Lichtenstein repair for elective inguinal hernias. Cochrane Database Syst Rev 7:CD008034Google Scholar
  28. 28.
    Lowham AS, Filipi CJ, Fitzgibbons RJ Jr, Stoppa R, Wantz GE, Felix EL et al (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair. Traditional and laparoscopic. Ann Surg 225(4):422–431CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General SurgeryWorthing HospitalWorthingUK

Personalised recommendations