The comparison of self-gripping mesh and conventional mesh in laparoscopic inguinal hernia repair: the results of meta-analysis

Outcomes of laparoscopic inguinal hernia repair using tail-anchor mesh fixation method: A retrospective study

BACKGROUND

Laparoscopic inguinal hernia repair (LIHR) has become increasingly popular, but recurrence remains a concern. This study introduces a novel tail-anchor mesh (TAM) fixation method for LIHR and evaluates the safety, feasibility and clinical outcomes of this technique in patients undergoing LIHR.

PATIENTS AND METHODS

Between June 2018 and June 2020, 412 patients with inguinal hernias were included in the study. LIHR with the TAM method was performed in 210 patients (Group A), whereas 202 patients underwent LIHR with conventional mesh fixation (Group B). Statistical analysis was used to compare clinical data between the two groups.

RESULTS

The recurrence rate and incidence of seroma were significantly lower in Group A (0.48% and 1.90%, respectively) than in Group B (3.96% and 9.41%, respectively) (P < 0.05). There were no significant differences between the groups in terms of demographic indicators, intraoperative blood loss, operation time, hospital stay or patient costs (all P > 0.05). Follow-ups at 24 and 53 months after discharge revealed no cases of wound infection, chronic pain or testicular atrophy in either group.

CONCLUSIONS

The TAM fixation method is a safe, feasible and reproducible technique for LIHR and offers superior outcomes compared with conventional mesh fixation, particularly in reducing recurrence and seroma formation.

Self-gripping versus polypropylene mesh for incisional hernia repair in a rat model

BACKGROUND

Self-gripping mesh, made of monofilament polypropylene and covered by a layer of polylactic acid micro-hooks, is applied in ventral hernia repair, whereas cytological change and collagen expression around the mesh are rarely reported. The objective of this research was to compare inflammatory response and collagen proliferation between self-gripping and polypropylene mesh in rat model of incisional hernia.

METHODS

Forty-five rats were randomly divided into unrepaired (UR) group, polypropylene (PP) mesh group, and self-gripping (SG) mesh group and euthanized at 1, 2 and 4 weeks postoperatively. The levels of inflammation, neovascularization, and collagen expression were measured by immunohistochemistry, quantitative real-time polymerase chain reaction, and Western blot.

RESULTS

One rat died and others developed typical incisional hernia in UR group, and hematoma, seroma, or wound infection were not observed in PP and SG groups. There was no significant difference in mesh shrinkage and inflammatory infiltration between PP and SG groups. With regard to neovascularization, 2 groups were comparable at 1 and 2 weeks, while the neovascularization score of PP group was statistically higher than that of SG group at 4 weeks. One week after surgery, the amounts of Collagen I (Col I) mRNA in PP group were significantly higher than SG group, while the amounts of Collagen III (Col III) mRNA were comparable between 2 groups. Two weeks following operation, the expressions of Col I mRNA and Col III mRNA in PP group were statistically lower than those in SG group. Four weeks postoperatively, the levels of Col I mRNA and Col III mRNA in PP group were significantly higher than those in SG group.

CONCLUSION

Self-gripping mesh induced comparable inflammatory response and collagen proliferation compared with polypropylene mesh in a rat model.

REGISTRATION NUMBER

ZZU-LAC2023080121.

Chronic inguinal pain post-hernioplasty. Laparo-endoscopic surgery vs lichtenstein repair: systematic review and meta-analysis

PURPOSE

Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia.

METHODS

Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI).

RESULTS

Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92).

CONCLUSIONS

This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.

Postoperative pain in transabdominal preperitoneal laparoscopic hernia repair with staple fixation versus self-fixation mesh

Background

The mesh fixation method is one of the multiple factors associated with chronic postoperative pain in inguinal hernia surgery. The aim of this study is to evaluate postoperative pain associated with the two available fixation strategies (staple fixation versus self-fixating mesh) used in our field.

Methods

We designed an observational study with retrospective cohorts to analyze postoperative pain in patients who underwent a laparoscopic transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh or staple fixation, which are the two available techniques in our field. A total of 296 patients who met the inclusion criteria were included between January 2014 and October 2021.

Results

The evaluated patients' median age was 66.0 (interquartile range (IQR): 20.75) years and were predominantly male (70.13 %). The proportion of participants with chronic pain was 3.20 % in the staple fixation group and 0 % in the self-fixating mesh group, with no statistically significant differences. On the other hand, recurrency in the staple fixation group was 2.28 % versus 3.90 % in the self-fixating mesh group, without statistically significant differences.

Conclusions

Self-fixating meshes have a trend towards smaller proportion of chronic pain and similar proportions of recurrence; therefore, they seem to be the best fixation method between the two mechanisms that are available in our field to prevent postoperative chronic pain.

Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh

BACKGROUND

The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM).

METHODS

We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days.

RESULTS

9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8 cm:18 cm with NSGM and 7 cm:15 cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days.

CONCLUSIONS

In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.

Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report

BACKGROUND

The primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation.

CASE PRESENTATION

A 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent.

CONCLUSIONS

Endoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.

The first experience with the Dextile anatomical mesh in laparoscopic inguinal hernia repair

BACKGROUND

The Dextile Anatomical mesh (Medtronic) is a polypropylene heavyweight mesh and has a 3D patented anatomical shape which adapts to the contours of the extra-peritoneal inguinal region without the need for fixation, potentially reducing the risk of hernia recurrence and chronic post-operative pain. This retrospective study will be the first study to assess the outcomes of the Dextile Anatomical mesh compared to another three-dimensional mesh, the 3DMax mesh (Bard).

METHODS

Between 2019 and 2022, all patients who underwent an elective unilateral inguinal hernia repair were assessed. 416 patients in the Dextile Anatomical mesh group and 540 patients in the 3DMax mesh group were included. Outcomes were intra- and post-operative complications, inguinal hernia recurrence and chronic post-operative inguinal pain.

RESULTS

No significant differences were found between the two groups regarding intra- and post-operative complications including wound infection, antibiotic use, hematoma, seroma, urinary retention and delayed wound healing. 1-year recurrence rate was comparable for the Dextile Anatomical mesh group and the 3DMax mesh group, respectively, 3.8% and 3.0%, P = 0.45. Chronic post-operative inguinal pain was similar for the Dextile Anatomical mesh (3.4%) and the 3DMax mesh (3.0%), P = 0.72.

CONCLUSION

This retrospective study comparing the relatively new Dextile Anatomical mesh (Medtronic) with the 3D Max mesh (Bard) in unilateral inguinal hernia repair showed that both meshes are safe and effective to use. There were no significant differences in intra-operative outcomes, recurrence rates and chronic post-operative inguinal pain.