Total extraperitoneal hernioplasty: does the long-term clinical course depend on the type of mesh?

INTRODUCTION: Implantation of alloplastic material has become a standard surgical procedure in inguinal hernia repair. The properties of different meshes are discussed as determinants of postoperative outcome. The aim of this study was to comparatively evaluate long-term results after total extraperitoneal hernioplasty (TEP) with a heavyweight polypropylene mesh (PP) and a lightweight polypropylene-polyglactin composite mesh (PP-PG) in a large patient population. MATERIALS AND METHODS: The study included patients who underwent TEP for elective repair of uni- or bilateral inguinal hernias between June 1997 and October 2004. We used a heavyweight PP mesh from June 1997 to February 2001 and a lightweight PP-PG mesh from March 2001 to October 2004. Patient data were evaluated by a prospective online registry, and long-term results were assessed by standardized ad hoc questionnaires after a minimum follow-up of 12 (12-103) months. RESULTS: Five hundred twenty-two patients aged 18-87 years underwent surgical repair of 655 inguinal hernias, and 370 (70.8%) were evaluated. TEP was performed with PP mesh in 192 cases and with PP-PG mesh in 169 cases. Nine patients died during follow-up; 14.6% (PP) versus 20.1% (PP-PG) patients complained of mild pain, and 8.9% (PP) versus 5.3% (PP-PG) patients reported moderate to severe pain (P > 0.05). Mild dysesthesias occurred in 13.5% of the PP group and 11.8% of the PP-PG group (P = 0.63). Moderate to severe dysesthesias were reported by 6.8% with a heavyweight mesh and by 3.0% with a lightweight mesh (P = 0.10). There were no significant differences with regard to the patients' postoperative return to normal daily activities. The recurrence rate was 5.2% with a PP mesh and 1.8% with a PP-PG mesh (P = 0.08). CONCLUSIONS: The long-term results after TEP showed no difference between PP and PP-PG meshes with regard to chronic pain, chronic dysesthesias, postoperative daily activities, and recurrence rates.

Laparoscopic and open inguinal hernia repair with alloplastic material: do the subjective and objective parameters differ in the long-term course?

INTRODUCTION: Management with alloplastic materials has become the standard procedure in inguinal hernia surgery. The aim of this study was to evaluate the long-term results after laparoscopic and open groin hernia repair with alloplastic material in a large patient population. MATERIALS AND METHODS: We included patients in the study who underwent elective laparoscopic total extraperitoneal (TEP) inguinal hernia repair or Lichtenstein surgery between January 1998 and December 2004 for either unilateral or bilateral inguinal hernia. Patient data were recorded by a prospective online data recording system and evaluated after a minimum follow-up time of 12 (12 to 103) months by standardized questionnaires. Both objective (chronic pain, chronic dysesthesia, recurrence, and postoperative recovery) and subjective (cosmetic result, scar formation, and the choice of surgical procedure) parameters were surveyed. RESULTS: Seven hundred eighty-two patients with 923 inguinal hernias underwent surgery in the study period. Five hundred fifty-three patients returned the questionnaire; 62 died during the follow-up. In the remaining 491 patients, TEP was used in 292 patients (375 hernias) and the Lichtenstein procedure in 199 patients (206 hernias). TEP was significantly superior to the Lichtenstein procedure for 2 objective parameters: chronic dysesthesia and return to normal work. Regarding the subjective parameters, TEP was superior in the cosmetic results and the choice of surgical procedure. 3.1% of the patients after TEP versus 8.5% after Lichtenstein were dissatisfied with the cosmetic result (P=0.008). If secondary inguinal hernia surgery were required, 89.4% of the patients would choose TEP again versus 76.1% the Lichtenstein procedure (P<0.001). CONCLUSIONS: Whereas the Lichtenstein procedure was not significantly better in any of the evaluated parameters, TEP was superior especially in the subjective parameters.