Abstract
Introduction
Secure fixation of the mesh in groin hernia repair is essential to avoid mesh dislocation. The fixation, however, is also thought to be a source of chronic postoperative pain. We tested the new self-fixating mesh Parietene progrip© vs. traditional suture fixating Lichtenstein repair in a double-blinded randomized study evaluating postoperative pain and the use of analgesics.
Methods
Fifty patients were randomized into two groups: Patients of group A (24 patients) were operated with the new self-fixating Parietene progrip© mesh without fixation sutures and patients of group B (26 patients) were operated with the traditional Lichtenstein repair. Postoperative course including pain and the use of analgesics were monitored. Patients were reinvestigated after 6 months regarding pain score and the amount of analgesics used during this interval. Primary end point was pain on the first operative day.
Results
The visual analog scale pain score showed at the first postoperative day a significantly lower level in group A than in group B (mean 17.9 vs. 32.3 mm, p = 0.03). Additionally, the cumulative dose of postoperatively required analgesics was lower in group A than in group B. The operative time in group A was significantly shorter than in group B. Six months after the operation, a trend toward a lower pain score was observed in group A, but this did not reach statistical significance.
Conclusions
This is the first randomized study to show a beneficial effect of the new self-fixating mesh on pain score. According to our investigations, operative time is reduced, which is a considerable fact with regard to economic aspects as well as the beneficial aspects for the patients. A study with a larger cohort of patients should be conducted to confirm the promising results of this exploratory study.
Similar content being viewed by others
References
Amid PK, Lichtenstein IL (1998) Long-term results and current status of the Lichtenstein open tension-free hernioplasty. Hernia 2:89–94
Kingsnorth A (2007) Classifying postherniorrhaphy pain syndromes following elective inguinal hernia repair. World J Surg 31:1766–1767
Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54
Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Fellander G, Heikkinen T (2005) One year results of a randomised controlled multi-centre study comparing Prolene and Vypro II-mesh in Lichtenstein hernioplasty. Hernia 9:223–227
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 Surg 93:1056–1059
Wijsmuller AR, Lange JF, van Geldere D, Simons MP, Kleinrensink GJ, Hop WC, Jeekel J, Lange JF (2007) Surgical techniques preventing chronic pain after Lichtenstein hernia repair: state-of-the-art vs daily practice in the Netherlands. Hernia 11:147–151
Wijsmuller AR, van Veen RN, Bosch JL, Lange JF, Kleinrensink GJ, Jeekel J (2007) Nerve management during open hernia repair. Br J Surg 94:17–22
Taylor C, Layani L, Liew V, Ghusn M, Crampton N, White S (2008) Laparoscopic inguinal hernia repair without mesh fixation, early result of a large randomised clinical trial. Surg Endosc 22:757–762
Mills IW, McDermott IM, Ratliff DA (1998) Prospective randomized controlled trial to compare skin staples and polypropylene for securing the mesh in inguinal hernia repair. Br J Surg 85:790–792
Paajanen H (2002) Do absorbable mesh sutures cause less chronic pain than nonabsorbable sutures after Lichtenstein inguinal herniorraphy? Hernia 6:26–28
Canonico S, Benevento R, Della Corte A, Fattopace A, Canonico R (2007) Sutureless tension-free hernia repair with human fibrin glue (Tissucol) in soccer players with chronic inguinal pain: initial experience. Int J Sports Med 11:11
Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193
Peiper C, Klinge U, Junge K, Schumpelick V (2002) Meshes in inguinal hernia repair. Zentralbl Chir 127:573–577
van Veen RN, Wijsmuller AR, Vrijland WW, Hop WC, Lange JF, Jeekel J (2007) Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: long-term chronic pain at 10 years. Surgery 142:695–698
Kumar S, Wilson RG, Nixon SJ, Macintyre IM (2002) Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg 89:1476–1479
Staal E, Nienhuijs SW, Keemers-Gels ME, Rosman C, Strobbe LJ (2008) The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia 12:153–157
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 91:44–48
Smedberg SG, Broome AE, Gullmo A (1984) Ligation of the hernial sac? Surg Clin North Am 64:299–306
Canonico S, Santoriello A, Campitiello F, Fattopace A, Corte AD, Sordelli I, Benevento R (2005) Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report. Hernia 9:330–333
Carbonell AM, Harold KL, Mahmutovic AJ, Hassan R, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair. Am Surg 69:688–691
Kapischke M, Schulz T, Schipper T, Tensfeldt J, Caliebe A (2008) Open versus laparoscopic incisional hernia repair: something different from a meta-analysis. Surg Endosc 5:5
Tung GA, Brody JM (1997) Contemporary imaging of athletic injuries. Clin Sports Med 16:393–417
Callesen T, Bech K, Andersen J, Nielsen R, Roikjaer O, Kehlet H (1999) Pain after primary inguinal herniorrhaphy: influence of surgical technique. J Am Coll Surg 188:355–359
Nienhuijs S, Staal E, Keemers-Gels M, Rosman C, Strobbe L (2007) Pain after open preperitoneal repair versus Lichtenstein repair: a randomized trial. World J Surg 18:18
Acknowledgment
The authors thank Ms. Alexandra Pries for critical reading of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Additional information
Matthias Kapischke and Heiko Schulze contributed equally to this study.
Rights and permissions
About this article
Cite this article
Kapischke, M., Schulze, H. & Caliebe, A. Self-fixating mesh for the Lichtenstein procedure—a prestudy. Langenbecks Arch Surg 395, 317–322 (2010). https://doi.org/10.1007/s00423-010-0597-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-010-0597-2