Top

Hernia

Published in:

01-10-2012 | Review

Lightweight versus heavyweight in inguinal hernia repair: a meta-analysis

Authors: J. Li, Z. Ji, T. Cheng

Published in: Hernia | Issue 5/2012

Abstract

Purpose

The aim of this article is to compare the outcomes of lightweight mesh and heavyweight mesh in inguinal hernia repair.

Method

A comprehensive literature search was undertaken to identify studies comparing the influence of lightweight and heavyweight meshes on inguinal hernia.

Results

The present meta-analysis pooled the effects of outcomes of a total 5,389 patients enrolled into 16 randomized controlled trials and 5 comparative studies. Lightweight mesh repair was associated with a significant less incidence of chronic postoperative pain [OR = 0.72, 95 % CI (0.57, 0.91)] and less feeling of foreign body than heavyweight mesh repair [OR = 0.50, 95 % CI (0.37, 0.67)]. Recurrence at 12 months was marginally increased in lightweight group (p = 0.05) [RD = 0.01, 95 % CI (0.00, 0.02)]. However, statistically there was no difference in the incidence of seroma [OR = 0.80, 95 % CI (0.52, 1.23)], infection [RD = −0.00, 95 % CI (−0.01, 0.00)], and testicular atrophy [RD = 0.01, 95 % CI (−0.01, 0.02)].

Conclusion

There was no difference regarding the incidence of seroma, infection, and testicular atrophy between lightweight mesh versus heavyweight mesh for inguinal hernia. There is a concern on the recurrence when lightweight mesh is used in large inguinal hernias. However, lightweight mesh repair do have advantages in terms of chronic postoperative pain and feeling of foreign body, and further well-structured trials with improved standardization of hernia types, operative techniques are necessary.

Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhaphies in Denmark; a prospective nationwide study. Lancet 358:1124–1128PubMedCrossRef

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 94:506–510PubMedCrossRef

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 165:665–673PubMedCrossRef

Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7PubMedCrossRef

Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R (2007) Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg 194:394–400PubMedCrossRef

Rutkow IM, Robbins AW (1993) Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am 73:413–426PubMed

Greca FH, de Paula JB, Biondo-Simoes ML, da Costa FD, da Silva AP, Time S, Mansur A (2001) The influence of differing pore sizes on the biocompatibility of two polypropylene meshes in the repair of abdominal defects. Experimental study in dogs. Hernia 5:59–64PubMedCrossRef

Klosterhallfen B, Klinge U, Hermanns B, Schumpelick V (2000) Pathology of traditional surgical nets for hernia repair after long-term implantation in humans. Chirurg 71:43–51

Weyhe D, Belyaev O, Muller C, Meurer K, Bauer KH, Papapostolou G, Uhl W (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 31:234–244PubMedCrossRef

10.

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 Surg 92:166–170PubMedCrossRef

11.

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 Surg 95:1226–1231PubMedCrossRef

12.

Bowne WB, Morgenthal CB, Castro AE, Shah P, Ferzli GS (2005) The role of endoscopic extraperitoneal herniorrhaphy: where do we stand in? Surg Endosc 2007 21:707–712CrossRef

13.

Higgins JPT, Green S (eds) (2008) Cochrane handbook for systematic reviews of interventions version 5.0.1. The Cochrane Collaboration, Chichester. Available at: http://www.cochrane-handbook.org. Updated September, 2008

14.

Egger M, Smith GD, Altman DG (2001) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Books, LondonCrossRef

15.

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 23:242–247PubMedCrossRef

16.

Akolekar D, Kumar S, Khan LR, de Beaux AC, Nixon SJ (2008) Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs. Hernia 12:39–43PubMedCrossRef

17.

Bringman S, Heikkinen TJ, Wollert S, Österberg J, Smedberg S, Granlund H, Ramel S, Felländer G, Anderberg B (2004) Early results of a single-blinded, randomized, controlled, Internet-based multicenter trial comparing Prolene and Vypro II mesh in Lichtenstein hernioplasty. Hernia 8:127–134PubMedCrossRef

18.

Bringman S, Wollert S, Österberg J, Smedberg S, Granlund H, Felländer G, Heikkinen T (2005) One year results of a randomised controlled multi-centre study comparing Prolene and Vypro II-mesh in Lichtenstein hernioplasty. Hernia 9:223–227PubMedCrossRef

19.

Bringman S, Wollert S, Österberg 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 93:1056–1059PubMedCrossRef

20.

Chowbey PK, Garg N, Sharma A, Khullar R, Soni V, Baijal M, Mittal T (2010) Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair. Surg Endosc 24:3073–3079PubMedCrossRef

21.

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 24:2735–2738PubMedCrossRef

22.

Heikkinen T, Wollert S, Österberg J, Smedberg S, Bringman S (2006) Early results of a randomized trial comparing Prolene and Vypro II-mesh in endoscopic extraperitoneal inguinal hernia repair (TEP) of recurrent unilateral hernias. Hernia 10:34–40PubMedCrossRef

23.

Horstmann R, Hellwig M, Classen C, Röttgermann 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 30:1742–1749PubMedCrossRef

24.

Khan LR, Kumar S, Nixon SJ (2006) Early results for new lightweight mesh in laparoscopic totally extra-peritoneal inguinal hernia repair. Hernia 10:303–308PubMedCrossRef

25.

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 14:39–45PubMedCrossRef

26.

Langenbach MR, Schmidt J, Zirngibl H (2006) Comparison of biomaterials: three meshes and TAPP for inguinal hernia. Surg Endosc 20:1511–1517PubMedCrossRef

27.

Langenbach MR, Schmidt J, Ubrig B, Zirngibl H (2008) Sixty-month follow-up after endoscopic inguinal hernia repair with three types of mesh: a prospective randomized trial. Surg Endosc 22:1790–1797PubMedCrossRef

28.

Lauscher JC, Yafaei K, Buhr HJ, Ritz JP (2008) Total extraperitoneal hernioplasty: does the long-term clinical course depend on the type of mesh? J Laparoendosc Adv Surg Tech 18:803–808CrossRef

29.

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 14:253–258PubMedCrossRef

30.

Paajanen H (2007) A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia. Hernia 11:335–339PubMedCrossRef

31.

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 91:44–48PubMedCrossRef

32.

Smietanski M, for the Polish Hernia Study Group (2008) Randomized clinical trial comparing a polypropylene with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty. Br J Surg 95:1462–1468PubMedCrossRef

33.

Bringman S, Wollert S, Österberg J, Heikkinen T (2005) Early results of a randomized multicenter trial comparing Prolene and Vypro II mesh in bilateral endoscopic extraperitoneal hernioplasty (TEP). Surg Endosc 19:536–540PubMedCrossRef

34.

Bay-Nielsen M, Nordin P, Nilsson E, Kehlet H (2001) Operative findings in recurrent hernia after a Lichtenstein procedure. Am J Surg 182:134–136PubMedCrossRef

35.

Mokete M, Earnshaw JJ (2001) Evolution of an inguinal hernia surgery practice. Postgrad Med J77:188–190

36.

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 87:854–859CrossRef

37.

Fitzgibbons RJ Jr (2005) Can we be sure polypropylene mesh causes infertility? Ann Surg 241:559–561PubMedCrossRef

38.

Harrell AG, Novitsky YW, Cristiano JA, Gersin KS, Norton HJ, Kercher KW, Heniford BT (2007) Prospective histologic evaluation of intra-abdominal prosthetics four months after implantation in a rabbit model. Surg Endosc 21:1170–1174PubMedCrossRef

39.

Klinge U, Conze J, Limberg W, Brucker C, Ottinger AP, Schumpelick V (1996) Pathophysiology of the abdominal wall. Chirurg 67:229–233PubMed

40.

Gao M, Han J, Tian J, Yang K (2010) Vypor II mesh for inguinal hernia repair, a meta analysis of Randomized controlled trials. Ann Surg 251:838–842PubMedCrossRef

41.

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):213–219PubMedCrossRef

42.

Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair. Surg Endosc 19:188–199PubMedCrossRef

43.

Scheidbach H, Tamme C, Tannapfel A, Lippert H, Kockerling F (2004) In vivo studies comparing the biocompatibility of various polypropylene meshes and their handling properties during endoscopic total extraperitoneal (TEP) patchplasty. Surg Endosc 18:211–220PubMedCrossRef

44.

Poobalan AS, Bruce J, Cairns W, Smith S, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54PubMedCrossRef

45.

Johner A, Faulds J, Wiseman SM (2011) Planned ilioinguinal nerve excision for prevention of chronic pain after inguinal hernia repair: A meta-analysis. Surgery (Epub ahead of print)

46.

Rosch R, Junge K, Quester R, Klinge U, Klosterhalfen B, Schumpelick V (2003) VyproII mesh in hernia repair: impact of polyglactin on long-term incorporation in rats. Eur Surg Res 35:445–450PubMedCrossRef

Title: Lightweight versus heavyweight in inguinal hernia repair: a meta-analysis
Authors: J. Li
Z. Ji
T. Cheng
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Hernia / Issue 5/2012
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-012-0928-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lightweight versus heavyweight in inguinal hernia repair: a meta-analysis

Abstract

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2012

Five-year results of a randomized clinical trial comparing a polypropylene mesh with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty

Unsuspected femoral hernia in patients with a preoperative diagnosis of a recurrent inguinal hernia, author reply

Management of congenital giant inguinal scrotal hernias in the newborn

Meta-analyses of lightweight versus conventional (heavyweight) mesh in inguinal hernia surgery

Questioning the favorable influence of nerve identification during open inguinal herniorrhaphy is misleading and may increases the risk of surgeons’ liability

Unusual clinical presentation of a preperitoneal hernia following endoscopic totally extraperitoneal inguinoscrotal hernia repair