Title: Comparison of Outcome between Light weight Mesh & Heavy Weight Mesh in Lichtenstein Groin Hernia Repair
Authors: Prince Muzafer Wani, Raheeb Ahmad Shah, Sajad Ahmad Para, Parvez Ahmad Bhat
DOI: http://dx.doi.org/10.18535/jmscr/v3i8.40
DIDS : 08.2015-XXXXXXX
Objectives: To compare the outcome of heavyweight mesh with lightweight mesh in the open repair of inguinal hernia. Method: The Study was a prospective one as a part of single centre randomized study carried over a period of two years 2012 to 2013 conducted on 70 male patients of inguinal hernia, the patients were randomly assigned to the groups of 35 patients each; one group underwent Lichtenstein mesh hernioplasty with heavyweight mesh (HWM) and other group underwent Lichtenstein mesh hernioplasty with lightweight mesh (LWM). Mesh placement and fixation was same in both groups. The patients were monitored in the general ward, all postoperative complications recorded. Severity of pain was analysed by VAS and the patients were assessed in the OPD after discharge, for any complications and recurrence. The patients were followed; complications if any, recorded as per the preset proforma and the two groups were analysed statistically, end point of study was follow up upto one year. Results: The study was conducted on 70 male patients of inguinal hernia, 35 patients in each group. The mean age of the patients in HWM was 54.11 (40-75) years and in LWM was 50.71 (40-66) years, (p >0.05). The difference in height and weight of patients in both the groups was not statistically significant (p >0.05). There was no statistically significant difference between times of occurrence of hernia to operation in both the groups (15 months vs. 14.14 months). Post-operative pain was assessed by Visual analogue scale. The pain scores were calculated at 12 hrs. 24 hrs.7th day, I month and at 6 months. There was no statistically significant difference in the pain scores at 12 hrs. 24 hrs. 7th day and at 1 month. However there was statistically significant difference in mean pain scores (VAS) at six months after operation between HWM group vs. LWM group (0.83 vs. 0.34) p < 0.05. The mean operating time in HWM group was 34.34 min. and that in LWM group was 32.68 min. this difference was statistically insignificant. The mean difference in postoperative stay in both HWM and LWM group was not statistically significant (p >0.05). There was no statistically significant difference between Heavyweight mesh group and Lightweight mesh group with respect to return to work (4.8 days in HWM vs. 4.28 days in LWM (p> 0.05). There was no recurrence of hernia in either group. Conclusion: Based on our study we believe that lightweight mesh offers benefits over heavyweight mesh for Lichtenstein inguinal hernia repair by reducing the incidence of chronic pain. These benefits did not appear to be at the expense of an increased rate of hernia recurrence. Keywords: Inguinal hernia, Lichtenstein repair, light weight mesh, heavy weight mesh, pain, recurrence. 1. JF Patino A history of the treatment of hernia. In: Hernia 4th Edition, Nisus LM, Condon RE, editors, Philadelphia, Lippincott.1995; 3–15.\ 2. Javid PJ, Brooks DC. In: Maingot’s Abdominal operations,11th ed., Zinner MJ, Ashley SW, editors, Mc-Graw Hill Companies, Inc. 1997; 104-105. 3. Svendsen SW, Frost P, Vad MV, Andersen JH. Risk and prognosis of inguinal hernia in relation to occupational mechanical exposures-a systemic review of the epidemiological evidence. Scand J Work Environ Health. 2013; 39(1): 5-26. 4. Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, et al. Hernia repair: the search for ideal meshes. Hernia 2010; 14(1): 81–87. 5. Khan N, Bangash A, Sadiq M, Hadi AU, and Hamid H. Polyglactine / Polypropylene Mesh vs. Propylene Mesh: Is There a Need for Newer Prosthesis in Inguinal Hernia? Saudi J Gastroenterol. 2010 Jan-Mar; 16(1): 8–13. 6. Nikkolo C, Lepner U, Murruste M, Vaasna T, Seepter H, Tikk T. Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty. Hernia 2010; 14(3): 253–258. 7. Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia 2006; 10(1): 79-82. 8. Hollinsky C, Sandberg S, Koch T, Seidler S. Biomechanical properties of lightweight versus heavyweight meshes for laparoscopic inguinal hernia repair and their impact on recurrence rates. Surg Endosc 2008; 22(12): 2679–2685. 9. Klosterhalfen B, Junge K, Klinge U. The light weight and large porus mesh concept for hernia repair. Expert Rev. Med. Devices 2005; 2(1): 1743-4440. 10. Chowbey PK, Garg N, Sharma A, Khullar R, Soni V, Baijal M, Mittal T. Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair. Surg Endosc 2010; 24(12): 3073–3079. 11. Uzzaman MM, Ratnasingham K, Ashraf N. Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. Hernia 2012; 16(5): 505–518. 12. Champault G, Bernard C, Rizk N, Polliand C. Inguinal hernia repair: the choice of prosthesis outweighs that of technique. Hernia 2007; 11(2): 125–128.Abstract
References