Abstract
Purpose
Lichtenstein inguinal hernia repair is associated with a low incidence of recurrence; however, the use of heavyweight mesh has been linked with chronic pain and foreign body sensation. It is hypothesized that the use of lightweight mesh may reduce these problems. This study aims to use meta-analysis to compare lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair.
Methods
Information was gathered from randomized controlled trials that compared lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. The Cochrane Library, Medline, EMBASE, trial registries, conference proceedings and reference lists were searched. Primary outcome measures were chronic pain, foreign body sensation and hernia recurrence. Secondary outcome measures were duration of surgery, mean visual analogue scale (VAS) pain scores, surgical-site infection, testicular atrophy and haematoma/seroma. The pooled Peto odds ratio (OR) was calculated for categorical data and weighted mean difference (WMD) for continuous data.
Results
Six trials with 1936 hernias were included. Lightweight mesh was associated with reduced chronic pain (OR = 0.67, 95% CI = 0.50–0.90; p < 0.01) and foreign body sensation (OR = 0.43, 95% CI = 0.21–0.93; p < 0.05). Lightweight mesh was also associated with lower VAS pain scores at 3 months after surgery (WMD = −0.35, 95% CI = −0.39 to −0.31; p < 0.0001). There were no differences in hernia recurrence (OR = 1.19, 95% CI = 0.54–2.64; p = 0.66) or other post-operative complications between the two groups.
Conclusions
The use of lightweight mesh in Lichtenstein inguinal hernia repair is associated with less chronic pain, and foreign body sensation compared with heavyweight mesh without any difference in recurrence.
Similar content being viewed by others
References
Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin N Am 83(5):1045–1051 v–vi
Kingsnorth AN, Gray MR, Nott DM (1992) Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hernia. Br J Surg 79(10):1068–1070
NICE (2004) Laparoscopic surgery for inguinal hernia repair. National Institute for Health and Clinical Excellence (NICE)
Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187(5):514–518
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(1):44–48
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):1–7
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(8):1122–1126
Di Vita G, Milano S, Frazzetta M, Patti R, Palazzolo V, Barbera C et al (2000) Tension-free hernia repair is associated with an increase in inflammatory response markers against the mesh. Am J Surg 180(3):203–207
Klinge U, Klosterhalfen B, Muller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165(7):665–673
Amid PK, Shulman AG, Lichtenstein IL, Hakakha M (1994) Biomaterials for abdominal wall hernia surgery and principles of their applications. Langenbecks Arch Chir 379(3):168–171
Klinge U, Conze J, Limberg W, Brucker C, Ottinger AP, Schumpelick V (1996) Pathophysiology of the abdominal wall. Chirurg 67(3):229–233
Junge K, Klinge U, Rosch R, Klosterhalfen B, Schumpelick V (2002) Functional and morphologic properties of a modified mesh for inguinal hernia repair. World J Surg 26(12):1472–1480
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 Med Surg 92(2):166–170
Koch A, Bringman S, Myrelid P, Smeds S, Kald A (2008) Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. Br J Med Surg 95(10):1226–1231
Bringman S, Heikkinen TJ, Wollert S, Osterberg J, Smedberg S, Granlund H et al (2004) Early results of a single-blinded, randomized, controlled, Internet-based multicenter trial comparing Prolene and Vypro II mesh in Lichtenstein hernioplasty. Hernia 8(2):127–134
Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H (2005) Fell, et al. One year results of a randomised controlled multi-centre study comparing Prolene and Vypro II-mesh in Lichtenstein hernioplasty. Hernia 9(3):223–227
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 Med Surg 93(9):1056–1059
Smietanski M (2008) Randomized clinical trial comparing a polypropylene with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty. Br J Med Surg 95(12):1462–1468
Smietanski M, Bury K, Smietanska IA, Owczuk R, Paradowski T (2011) Polish Hernia Study G. Five-year results of a randomised controlled multi-centre study comparing heavy-weight knitted versus low-weight, non-woven polypropylene implants in Lichtenstein hernioplasty. Hernia 15(5):495–501
International Association for the Study of Pain SoT (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl 3:S1–S226
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):1–12
Higgins JPT, Green S (2008) Cochrane handbook for systematic reviews of interventions: the Cochrane collaboration
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Demets DL (1987) Methods for combining randomized clinical trials: strengths and limitations. Stat Med 6(3):341–350
Khan N, Bangash A, Sadiq M, Ul Hadi A, Hamid H (2010) Polyglactine/polypropylene mesh vs. propylene mesh: is there a need for newer prosthesis in inguinal hernia? Saudi J Gastroenterol 16(1):8–13
Champault G, Bernard C, Rizk N, Polliand C (2007) Inguinal hernia repair: the choice of prosthesis outweighs that of technique. Hernia 11(2):125–128
Torcivia A, Vons C, Barrat C, Dufour F, Champault G (2011) Influence of mesh type on the quality of early outcomes after inguinal hernia repair in ambulatory setting controlled study: Glucamesh(R) vs Polypropylene(R). Langenbecks Arch Surg 396(2):173–178
Paajanen H (2007) A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia. Hernia 11(4):335–339
Puccio F, Solazzo M, Marciano P (2005) Comparison of three different mesh materials in tension-free inguinal hernia repair: prolene versus Vypro versus surgisis. Int Surg 90(3 Suppl):S21–S23
Nikkolo C, Lepner U, Murruste M, Vaasna T, Seepter H, Tikk T (2010) Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty. Hernia 14(3):253–258
Eklund A, Carlsson P, Rosenblad A, Montgomery A, Bergkvist L, Rudberg C (2010) Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair. Br J Surg 97(5):765–771
Gao M, Han J, Tian J, Yang K (2010) Vypro II mesh for inguinal hernia repair: a meta analysis of randomized controlled trials. Ann Surg 251(5):838–842
Chui LB, Ng WT, Sze YS, Yuen KS, Wong YT, Kong CK (2010) Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia. Surg Endosc 24(11):2735–2738
Horstmann R, Hellwig M, Classen C, Rottgermann S, Palmes D (2006) Impact of polypropylene amount on functional outcome and quality of life after inguinal hernia repair by the TAPP procedure using pure, mixed, and titanium-coated meshes. World J Surg 30(9):1742–1749
Mokete M, Earnshaw JJ (2001) Evolution of an inguinal hernia surgery practice. Postgrad Med J 77(905):188–190
van Veen RN, Wijsmuller AR, Vrijland WW, Hop WC, Lange JF, Jeekel J (2007) Long-term follow-up of a randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg 94(4):506–510
EU Hernia Trialists Collaboration (2000) Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87(7):854–859
Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B et al (2010) Hernia repair: the search for ideal meshes. Hernia 14(1):81–87
Ferzli GS, Edwards ED, Khoury GE (2007) Chronic pain after inguinal herniorrhaphy. J Am Coll Surg 205(2):333–341
Weyhe D, Belyaev O, Muller C, Meurer K, Bauer KH, Papapostolou G et al (2007) Improving outcomes in hernia repair by the use of light meshes–a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31(1):234–244
Khan LR, Liong S, de Beaux AC, Kumar S, Nixon SJ (2010) Lightweight mesh improves functional outcome in laparoscopic totally extra-peritoneal inguinal hernia repair. Hernia 14(1):39–45
Agarwal BB, Agarwal KA, Mahajan KC (2009) Prospective double-blind randomized controlled study comparing heavy- and lightweight polypropylene mesh in totally extraperitoneal repair of inguinal hernia: early results. Surg Endosc 23(2):242–247
Markar SR, Karthikesalingam A, Alam F, Tang TY, Walsh SR, Sadat U (2010) Partially or completely absorbable versus nonabsorbable mesh repair for inguinal hernia: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech 20(4):213–219
Smietanski M, Bigda J, Zaborowski K, Worek M, Sledzinski Z (2009) Three-year follow-up of modified Lichtenstein inguinal hernioplasty using lightweight poliglecaprone/polypropylene mesh. Hernia 13(3):239–242
Zhao G, Gao P, Ma B, Tian J, Yang K (2009) Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg 250(1):35–42
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uzzaman, M.M., Ratnasingham, K. & Ashraf, N. Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. Hernia 16, 505–518 (2012). https://doi.org/10.1007/s10029-012-0901-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-012-0901-x