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UltraPro Hernia System, Prolene Hernia System and Lichtenstein for primary inguinal hernia repair: 3-year outcomes of a prospective randomized controlled trial

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Abstract

Purpose

Chronic pain and discomfort are common after inguinal hernia repair (IHR). In this study, results from a 3-year follow-up from a randomized controlled study comparing three different mesh repairs for postoperative pain, discomfort, Quality of Life (QoL) and patient satisfaction are reported.

Methods

Between November 1, 2006 and January 31, 2009, 309 men, who underwent day surgery for primary unilateral inguinal hernia under local anesthesia, were randomized to three different mesh repairs; UltraPro Hernia System (U), Prolene Hernia System (P) and Lichtenstein procedure (L).

Results

Preoperatively, there were no differences between groups regarding demographics, symptoms, inguinal pain or QoL (SF-36 and a hernia-specific questionnaire). Operating time, postoperative pain, complications and time to full recovery were similar. At 36 months, 21 patients indicated pain [L, n = 6, P, n = 6 and U, n = 9; VAS (median (IQR)): L 0.4 (0.2–1.7), P 0.2 (0.1–2.3) and U 1.6 (0.7–4.6), p = ns]. Physical QoL was reduced in all groups before surgery and was similarly increased to normal levels after 3 months without further changes throughout the study. Although 92 % of participants were satisfied, sixteen percent reported any discomfort from the groin (ns between groups). Five recurrences were reported (L, n = 2, P, n = 1 and U, n = 2, p = ns).

Conclusions

After 3 years of follow-up, all three procedures provided equally good results regarding, pain, discomfort and QoL and could therefore be recommended for primary IHR in LA.

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Abbreviations

IHR:

Inguinal hernia repair

QoL:

Quality of life

SF-36:

Short form 36

VAS:

Visual analogue scale

PCS:

Physical component score

MCS:

Mental component score

N:

No inguinal pain preoperatively

P:

Reported inguinal pain preoperatively

References

  1. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 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(3):394–400

    Article  PubMed  Google Scholar 

  3. 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(1):48–54

    Article  PubMed  Google Scholar 

  4. van de Jonge PH, Lloyd A, Horsfall L, Tan R, O’Dwyer PJ (2008) The measurement of chronic pain and health-related quality of life following inguinal hernia repair: a review of the literature. Hernia 12(6):561–569

    Article  Google Scholar 

  5. Di Vita G, Milano S, Frazzetta M, Patti R, Palazzolo V, Barbera C, Ferlazzo V, Leo P, Cillari E (2000) Tension-free hernia repair is associated with an increase in inflammatory response markers against the mesh. Am J Surg 180(3):203–207

    Article  PubMed  Google Scholar 

  6. Ferzli GS, Edwards E, Al-Khoury G, Hardin R (2008) Postherniorrhaphy groin pain and how to avoid it. Surg Clin N Am 88(1):203–216 (x–xi)

    Article  PubMed  Google Scholar 

  7. 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(2):166–170

    Article  PubMed  Google Scholar 

  8. 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(9):1056–1059

    Article  CAS  PubMed  Google Scholar 

  9. Magnusson J, Nygren J, Thorell A (2012) Lichtenstein, prolene hernia system, and UltraPro Hernia System for primary inguinal hernia repair: one-year outcome of a prospective randomized controlled trial. Hernia 16(3):277–285

    Article  CAS  PubMed  Google Scholar 

  10. Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8(1):1–7

    Article  PubMed  Google Scholar 

  11. Gilbert AIGM, Voigt WJ (1999) A bilayer patch device for inguinal hernia repair. Hernia 3(3):161–166

    Article  Google Scholar 

  12. Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95(1):69–76

    Article  CAS  PubMed  Google Scholar 

  13. Burney RE, Jones KR, Coon JW, Blewitt DK, Herm A, Peterson M (1997) Core outcomes measures for inguinal hernia repair. J Am Coll Surg 185(6):509–515

    Article  CAS  PubMed  Google Scholar 

  14. Hair A, Paterson C, Wright D, Baxter JN, O’Dwyer PJ (2001) What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg 193(2):125–129

    Article  CAS  PubMed  Google Scholar 

  15. Sanjay P, Harris D, Jones P, Woodward A (2006) Randomized controlled trial comparing prolene hernia system and lichtenstein method for inguinal hernia repair. ANZ J Surg 76(7):548–552

    Article  PubMed  Google Scholar 

  16. Dalenback J, Andersson C, Anesten B, Bjorck S, Eklund S, Magnusson O, Rimback G, Stenquist B, Wedel N (2009) Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. The BOOP study: bi-layer and connector, on-lay, and on-lay with plug for inguinal hernia repair. Hernia 13(2):121–129 (discussion 231)

    Article  CAS  PubMed  Google Scholar 

  17. Pierides G, Vironen J (2011) A prospective randomized clinical trial comparing the Prolene Hernia System(R) and the Lichtenstein patch technique for inguinal hernia repair in long term: 2- and 5-year results. Am J Surg 202(2):188–193

    Article  PubMed  Google Scholar 

  18. Mayagoitia JC, Prieto-Diaz Chávez E, Suárez D, Cisneros HA, Tene CE (2006) Predictive factors comparison of complications and recurrences in three tension-free herniorraphy techniques. Hernia 10:147–151

    Article  CAS  PubMed  Google Scholar 

  19. 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

    Article  CAS  PubMed  Google Scholar 

  20. Hasegawa S, Yoshikawa T, Yamamoto Y, Ishiwa N, Morinaga S, Noguchi Y, Ito H, Wada N, Inui K, Imada T et al (2006) Long-term outcome after hernia repair with the prolene hernia system. Surg Today 36(12):1058–1062

    Article  PubMed  Google Scholar 

  21. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 91(10):1372–1376

    Article  CAS  PubMed  Google Scholar 

  22. Lawrence K, McWhinnie D, Jenkinson C, Coulter A (1997) Quality of life in patients undergoing inguinal hernia repair. Ann R Coll Surg Engl 79(1):40–45

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Mathur S, Bartlett AS, Gilkison W, Krishna G (2006) Quality of life assessment in patients with inguinal hernia. ANZ J Surg 76(6):491–493

    Article  PubMed  Google Scholar 

  24. Zieren J, Kupper F, Paul M, Neuss H, Muller JM (2003) Inguinal hernia: obligatory indication for elective surgery? A prospective assessment of quality of life before and after plug and patch inguinal hernia repair. Langenbeck’s Arch Surg (Deutsche Gesellschaft fur Chirurgie) 387(11–12):417–420

    Google Scholar 

  25. Bisgaard T, Bay-Nielsen M, Christensen IJ, Kehlet H (2007) Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 94(8):1038–1040

    Article  CAS  PubMed  Google Scholar 

  26. http://www.svensktbrackregister.se

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Acknowledgments

This work was supported by grants from the Swedish Research Council (No 09101), Karolinska Institutet, Stockholm, Stockholm City Council, and The Erling-Persson Family Foundation, Sweden. We would like to thank Karin Sadarangani-Lindström, Anette Bratt, Monica Johansson and Charlotte Norberg-Jönsson for their assistance in patient recruitment, excellent nursing and technical support.

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Correspondence to J. Magnusson.

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The authors declare that they have no conflict of interest.

Ethical approval

The study (KCTR-CT20090022) was approved by the regional ethics committee.

Informed consent

All patients included in the study gave their written informed consent.

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Magnusson, J., Nygren, J., Gustafsson, U.O. et al. UltraPro Hernia System, Prolene Hernia System and Lichtenstein for primary inguinal hernia repair: 3-year outcomes of a prospective randomized controlled trial. Hernia 20, 641–648 (2016). https://doi.org/10.1007/s10029-016-1507-5

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  • DOI: https://doi.org/10.1007/s10029-016-1507-5

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