FROM ANNALS OF SURGERY
Lightweight mesh has no significant benefit over heavyweight mesh for inguinal hernia repair and was associated with greater pain and higher risk of recurrence, based on data from a randomized trial of 950 patients published in the May issue of the Annals of Surgery.
Although the use of mesh for hernia surgery has been associated with lower recurrence rates and less chronic pain in open hernia repair procedures, the benefits of lightweight vs. heavyweight mesh for laparoscopic procedures has not been well studied, “and there is no consensus which type of mesh is optimal in these procedures,” wrote Dr. Josephina P.J. Burgmans of Diakonessenhuis Utrecht/Zeist (the Netherlands) and colleagues (Ann. Surg. 2016;263:862-6).
To compare the clinical outcomes for patients who received lightweight vs. heavyweight mesh in hernia repairs, the researchers randomized 478 patients to a lightweight-mesh group and 471 to a heavyweight-mesh group. One patient was excluded because the type of mesh was unknown. The study population included men older than 18 years with a primary, reducible, unilateral inguinal hernia who underwent surgery at a single center with one of four surgeons between March 2010 and October 2012. Demographic characteristics were similar between the two groups, as were preoperation pain, operation time, and complications during and after surgery.
At 1 year post surgery, the prevalence of reported relevant pain was significantly higher in the lightweight group, compared with the heavyweight group (2.9% vs. 0.7%). The difference remained statistically significant at 2 years’ follow-up, with relevant pain reported in 3.0% of the lightweight group and 0.9% of the heavyweight group; the difference also remained significant after controlling for factors including age, body mass index, hernia type, severe preoperative pain, recurrence, and surgeon).
Recurrence rates were similar between the two groups at 3 months (two cases in each group), but recurrences became more common in the lightweight group, compared with the heavyweight group, at 1 year (1.7% vs. 0.6%) and significantly more common at 2 years (2.7% vs. 0.8%). The difference remained significant after controlling for multiple variables including hernia type, operating time, surgeon, and body mass index.
No significant differences in foreign body feeling, testicular pain, or sexual-related pain or discomfort were reported between the two groups at the 1-year and 2-year follow-ups.
The study’s strengths include the large patient population and prospective data collection, the researchers noted. The findings were limited by the small number of patients with relevant pain at 1 and 2 years; the homogenous, male-only study population; and the use of questionnaires, which might affect the accuracy of recurrence-rate reports. The results, however, suggest that “there is no benefit for lightweight [meshes] and a conventional heavyweight standard polypropylene 10 cm × 15 cm mesh is recommended for laparoscopic inguinal hernia repair,” Dr. Burgmans and associates wrote
The study was sponsored in part by a grant to the Hernia Centre Zeist from Johnson & Johnston. The researchers had no other relevant financial conflicts to disclose.