Top

Surgical Endoscopy

Published in:

01-01-2013

Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh

Authors: Alfredo Moreno-Egea, Andrés Carrillo-Alcaraz, Víctor Soria-Aledo

Published in: Surgical Endoscopy | Issue 1/2013

Abstract

Background

The use of lightweight meshes in incisional hernia repair could have beneficial effects on quality of life. This study aimed to compare a new titanium-coated lightweight mesh with a standard composite mesh after laparoscopic incisional hernia repair.

Methods

A randomized controlled single-center clinical trial was designed using the basic principle of one unit, one surgeon, one technique (midline incisional hernia with a laparoscopic approach), and two meshes: a lightweight titanium-coated mesh (group 1) and a medium-weight collagen-polyester composite mesh (group 2) used in 102 patients. The primary end points were pain and recurrence. The secondary end points were morbidity and patient outcomes (analgesic consumption, return to everyday activities).

Results

The postoperative complication rates were similar for the two meshes. Pain was significantly less common in group 1 than in group 2 at 1 month (P = 0.029) but was similar for the two groups at 6 months and 1 year. There was a significant difference between the two groups in the average use of analgesics: 6.1 days in group 1 versus 1.6 days in group 2 (P < 0.001). The lightweight group returned to everyday activities after 6.9 days versus 9.7 days for the composite group (P < 0.001). The rate of recurrence did not differ between the two groups at the 2-year follow-up evaluation.

Conclusions

The light titanium-covered polypropylene mesh was associated with less postoperative pain in the short term, lower analgesic consumption, and a quicker return to everyday activities than the Parietex composite medium-weight mesh. The recurrence rates at 2 years showed no difference between the two groups.

Earle DB, Mark LA (2008) Prosthetic material in inguinal hernia repair: how do I choose? Surg Clin North Am 88:179–201CrossRefPubMed

Bittner R, Schmedt CG, Leibl BJ et al (2011) Early postoperative and one-year results of a randomized controlled trial comparing the impact of extralight titanized polypropylene mesh and traditional heavyweight polypropylene mesh on pain and seroma production in laparoscopic hernia repair (TAPP). World J Surg 35(8):1791–1797CrossRefPubMed

O’Dwyer PJ, Kingsnorth AN, Molloy RG et al (2005) Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg 92:166–170CrossRefPubMed

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 23:242–247CrossRefPubMed

Chowbey PK, Garg N, Sharma A et al (2010) Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair. Surg Endosc 24:3073–3079CrossRefPubMed

Chui LB, Ng WT, Sze YS et al (2010) Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia. Surg Endosc 24:2735–2738CrossRefPubMed

Nikkolo C, Lepner U, Murruste M et al (2010) Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty. Hernia 14:253–258CrossRefPubMed

Scheidbach H, Tannapfel A, Schmidt U et al (2004) Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh: an animal experimental model. Eur Surg Res 36:313–317CrossRefPubMed

Schopf S, von Ahnen T, von Ahnen M et al (2011) Chronic pain after laparoscopic transabdominal preperitoneal hernia repair: a randomized comparison of light and extralight titanized polypropylene mesh. World J Surg 35:302–310CrossRefPubMed

10.

Junge K, Rosch R, Klinge U et al (2005) Titanium coating of a polypropylene mesh for hernia repair: effect on biocompatibility. Hernia 9:115–119CrossRefPubMed

11.

Schug-Pass C, Tamme C, Tannapfel A et al (2006) A lightweight polypropylene mesh (TiMesh) for laparoscopic intraperitoneal repair of abdominal wall hernias: comparison of biocompatibility with the DualMesh in an experimental study using the porcine model. Surg Endosc 20:402–409CrossRefPubMed

12.

Koch A, Bringman S, Myrelid P et al (2008) Randomized clinical trial of groin hernia repair with titanium-coated lightweight mesh compared with standard polypropylene mesh. Br J Surg 95:1226–1231CrossRefPubMed

13.

Bellón JM, Rodríguez M, García-Honduvilla N et al (2009) Comparing the behavior of different polypropylene meshes (heavy and lightweight) in an experimental model of ventral hernia repair. J Biomed Mater Res B Appl Biomater 89B:448–455CrossRef

14.

Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernia. Hernia 13:407–414CrossRefPubMed

15.

Moreno-Egea A, Bustos JA, Girela E et al (2010) Long-term results of laparoscopic repair of incisional hernias using an intraperitoneal composite mesh. Surg Endosc 24:359–365CrossRefPubMed

16.

Moreno-Egea A (2002) In: Morales-Conde S (ed) Laparoscopic ventral hernia repair. Springer Verlag, Paris, pp 139–159

17.

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

18.

Kehlet H, Bay-Nielsen M, Kingsnorth A (2002) Chronic postherniorrhaphy pain: a call for uniform assessment. Hernia 6:178–181CrossRefPubMed

19.

Forbes SS, Eskicioglu C, McLeod RS et al (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858CrossRefPubMed

20.

Sajid MS, Bokhari SA, Mallick AS et al (2009) Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 197:64–72CrossRefPubMed

21.

Sains PS, Tilney HS, Purkayastha S et al (2006) Outcomes following laparoscopic versus open repair of incisional hernia. World J Surg 30:2056–2064CrossRefPubMed

22.

Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165CrossRefPubMed

23.

Gray SH, Hawn MT, Itani KMF (2008) Surgical progress in inguinal and ventral incisional hernia repair. Surg Clin North Am 88:17–26CrossRefPubMed

24.

Breuing K, Butler CE, Ferzoco S, Ventral Hernia Working Group et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558CrossRefPubMed

25.

Bringman S, Conze J, Cuccurullo D et al (2010) Hernia repair: the search for ideal meshes. Hernia 14:81–87CrossRefPubMed

26.

Cobb WS, Kercher KW, Heniford BT (2005) The argument for lightweight polypropylene mesh in hernia repair. Surg Innov 12:63–69CrossRefPubMed

27.

Brown CN, Finch JG (2010) Which mesh for hernia rpair? Ann R Coll Surg Engl 92:272–278CrossRefPubMed

28.

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

29.

Khan LR, Liong S, de Beaux AC et al (2010) Lightweight mesh improves functional outcome in laparoscopic totally extraperitoneal inguinal hernia repair. Hernia 14:39–45CrossRefPubMed

30.

Bellón JM, Rodríguez M, García-Honduvilla N et al (2007) Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes. Am J Surg 194:68–74CrossRefPubMed

31.

Pascual G, Rodríguez M, Gomez-Gil V et al (2008) Early tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia. Surgery 144:427–435CrossRefPubMed

32.

Akolekar D, Kumar S, Khan LR et al (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 12:39–43CrossRefPubMed

33.

Bringman S, Wollert S, Österberg S et al (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 93:1056–1059CrossRefPubMed

34.

Moreno-Egea A, Carrillo A, Aguayo JL (2012) Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study. Am J Surg 203(1):87–94CrossRefPubMed

35.

Moreno-Egea A, Lirón R, Girela E et al (2001) Laparoscopic repair of ventral and incisional hernias using a new composite mesh (Parietex): initial experience. Surg Laparosc Endosc Percutan Tech 11:103–106PubMed

36.

Moreno-Egea A, Torralba JA, Girela E et al (2004) Immediate, early, and late morbidity with laparoscopic ventral hernia repair and tolerance to composite mesh. Surg Laparosc Endosc Percutan Tech 14:130–135CrossRefPubMed

37.

Moreno-Egea A, Carrillo A, Aguayo JL (2008) Midline versus nonmidline laparoscopic incisional hernioplasty: a comparative study. Surg Endosc 22:744–749CrossRefPubMed

38.

Bellón JM (2007) Abdominal wall hernia repair: a comparison of Sepramesh and Parietex composite mesh in a rabbit hernia model. J Am Coll Surg 205:192CrossRefPubMed

39.

Hollinsky C, Sandberg S, Koch T et al (2008) Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates. Surg Endosc 22:2679–2685CrossRefPubMed

40.

Tamme C, Garde N, Klingler A et al (2005) Totally extraperitoneal inguinal hernioplasty with titanium-coated lightweight polypropylene mesh: early results. Surg Endosc 19:1125–1129CrossRefPubMed

41.

Horstmann R, Hellwig M, Classen C et al (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 30:1742–1749CrossRefPubMed

42.

Bittner R, Leibl BJ, Kraft B et al (2011) One-year results of a prospective, randomised clinical trial comparing four meshes in laparoscopic inguinal hernia repair (TAPP). Hernia 15(5):503–510CrossRefPubMed

Title: Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh
Authors: Alfredo Moreno-Egea
Andrés Carrillo-Alcaraz
Víctor Soria-Aledo
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 1/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2425-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Ensuring competency: Are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel?

Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of Hospital Episode Statistics

SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer

The unacknowledged incidence of laparoscopic stapler malfunction

Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery

Diet-induced obesity and ethanol impair progression of hepatocellular carcinoma in a mouse mesenteric vein injection model