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Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP)

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Abstract

Background

This prospective study aimed to evaluate the impact of transabdominal preperitoneal patch plasty (TAPP) with implantation of a lightweight mesh (<50 g/m²) fixed by fibrin glue on the occurrence of chronic pain and sexual dysfunction in hernia patients.

Methods

Patients were examined before TAPP, early and late postoperatively. The primary end point of the study was pain-related functional impairment 6 months after the operation as assessed by the validated assessment scale (AAS). For the first time, patients without any pain before surgery were compared with patients experiencing preoperative pain. Furthermore, the patients were asked about the frequency and extent of impairment in their sexual activities. A secondary end point was chronic pain in relation to the type of mesh fixation (glue vs clip).

Results

The study criteria was met by 276 patients. The dropout rate after 6 months was 2.9%. Mesh fixation was performed with glue for 212 patients and with clip for 64 patients. Chronic pain with significant impairment of daily activities was experienced by 42% of patients before the operation, which decreased to 8.3% after TAPP. The mean level of impairment, assessed by AAS, decreased from 11.2 preoperatively to 2 postoperatively (p < 0.001). The clip patients had more pain on days 4 and 7 postoperatively (p < 0.05) but not later. A majority of the patients (78%) experiencing pain before the operation were pain free 6 months after TAPP. New pain was seen in 7.4% of the patients but was only mild (numeric analog scale [NAS], 1–3; 78% of patients) or moderate (NAS, 4–6; 11% of patients). The only patient with severe pain (NAS, 8) had a clip fixation. Frequency of sexual dysfunction decreased after TAPP (p < 0.05).

Conclusion

The TAPP procedure with implantation of a lightweight mesh fixed by glue is a highly effective option for preventing chronic pain in inguinal hernia repair. Fibrin fixation seems superior to clip fixation during the early postoperative period. However, for confirmation of results, a randomized study is recommended.

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Acknowledgments

The biometrics was done in cooperation with the Institut for Biometrics, University of Tübingen (uni-tübingen.de\biometrie). The study was funded by a grant from Aesculap AG (Tuttlingen, Germany), Baxter Deutschland GmbH (Unterschleißheim, Germany), and the Lundback Foundation (Denmark) to cover the cost (room, materials, psychologists). Neither physician fees or royalties nor patient reimbursements were provided. In addition, none of the authors has any direct or indirect financial interest in the products.

Disclosures

Reinhard Bittner, Eliza Gmähle, Björn Gmähle, Jochen Schwarz, Eske Aasvang, and Henrik Kehlet have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Center for Minimal Invasive Surgery, Bethesda Krankenhaus Stuttgart (formerly Marienhospital Stuttgart), Hohenheimer Strasse 21, 70184, Stuttgart, Germany

    Reinhard Bittner & Jochen Schwarz

  2. Psychologist, Waiblinger Str. 19, 70372, Stuttgart, Germany

    Eliza Gmähle

  3. Psychologist–getifex–Consulting, Stuttgart, Germany

    Björn Gmähle

  4. Section for Pathophysiology, 4074 Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Eske Aasvang & Henrik Kehlet

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  1. Reinhard Bittner
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  2. Eliza Gmähle
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  5. Eske Aasvang
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Correspondence to Reinhard Bittner.

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Bittner, R., Gmähle, E., Gmähle, B. et al. Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP). Surg Endosc 24, 2958–2964 (2010). https://doi.org/10.1007/s00464-010-1140-9

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  • DOI: https://doi.org/10.1007/s00464-010-1140-9

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