Authors: R Bittner B J Leibl B Kraft J Schwarz
Publish Date: 2011/04/03
Volume: 15, Issue: 5, Pages: 503-510
Abstract
A low rate of chronic pain and maximum postoperative comfort are the main goals today in inguinal hernia repair This fourarm randomised trial compares these parameters after laparoscopic hernia repair TAPP with a standard heavyweight mesh HW a pure middleweight polypropylene mesh MW a lightweight composite polypropylene mesh LW or a titanised lightweight mesh TLW The primary endpoint of the study was the incidence of chronic pain of any severity at the site of hernia repair at 1 yearA total of 600 patients with a laparoscopic inguinal hernia repair and a defect diameter of 3–5 cm were included in the trial In all patients a noninvasive mesh fixation technique was performed using fibrin glue Patients were assessed for pain foreign body sensation and physical activities preoperatively early postoperatively at 4 weeks at 6 months and at 1 year by questionnaire and were examined clinically Postoperatively seroma formation was measured by ultrasoundAt 1 year after TAPP frequency of pain did not differ statistically between the four groups depending on type of activity between 6–8 with HW mesh 2–4 with middleweight mesh and 2–47 with both lightweight meshes average intensity of pain was very low at between VAS 04 ± 31 and 15 ± 78 MW LW TLW and between 19 ± 86 and 23 ± 91 HW depending on activity ns Early postoperatively between 313 LW and 213 TLW of the patients needed pain medication ns at 1 year this percentage had dropped to 03 one HW one MW Foreign body sensation did not differ but impairment of physical activities P = 00437 was significantly less in the MW LW and TLW group 6–127 compared to HW 153 at 4 weeks at 1 year this percentage was between 0 and 13 nsCompared to HW mesh the use of MW LW and TLW meshes for laparoscopic hernia repair did not significantly affect rate of chronic pain but seemed to improve early postoperative convalescence No difference was found between middleweight pure polypropylene MW composite lightweight LW or titanised lightweight polypropylene TLW meshesThe authors thank PD Dr S Sauerland MD MPH Institute for Research in Operative Medicine IFOM University of Witten/Herdecke Cologne Germany for his assistance in planning the study and in the calculation of the number of the study population and Mr U Schmidt StatConsult Gesellschaft für Klinische und Versorgungsforschung mbH Magdeburg for statistical analyses
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