Avoiding migration at open mesh plug inguinal hernioplasty

Risk of adverse outcomes by plug and flat mesh following 90,319 open inguinal hernia repairs

PURPOSE

We sought to evaluate the risks for reoperation, recurrence, and groin pain following open inguinal hernia repair with a plug versus flat mesh.

METHODS

We conducted a cohort study including 90,319 patients ≥ 18 years who underwent first elective open inguinal hernia repair with polyester/polypropylene mesh within a US integrated healthcare system (1/2010-6/2023). Plug versus flat mesh were the treatment groups. Reoperation related to the index hernia repair, as well as other reoperation reasons, and recurrence during follow-up were primary outcomes, while 5-year postoperative groin pain (excluding first 6-month postoperative acute recovery period) was a secondary outcome. Multiple Cox regression was used to evaluate risk of longitudinal outcomes, while multiple logistic regression was used to evaluate groin pain, with covariate adjustment.

RESULTS

Plugs were used in 37,490 (41.5%) repairs; plug use declined from 53.0% in 2010 to 13.9% in the first six months of 2023. No difference in risk for reoperation (hazard ratio [HR] = 1.03, 95% confidence interval [CI] = 0.92-1.16) or recurrence (HR = 0.93, 95% CI = 0.83-1.04) was found for plug compared to flat mesh. A higher risk of reoperation for device infection was observed with plug use compared to flat mesh (HR = 2.71, 95% CI = 1.09-6.77). In adjusted analysis, no difference in the likelihood of groin pain was observed (odds ratio = 1.08, 95% CI = 1.00-1.17).

CONCLUSION

Plug mesh for open inguinal hernia repairs were not found to have improved outcomes compared to flat mesh but a higher risk of reoperation for infection. These findings align with the current literature, which generally advises against the use of mesh plugs due to associated risks and complications.

Quality of life assessment of patients after removal of late-onset infected mesh following open tension-free inguinal hernioplasty: 3-year follow-up

PURPOSE

Open tension-free inguinal hernioplasty is one of the common surgical methods used today to treat inguinal hernias due to its simplicity and low recurrence rate. With the widespread use of tension-free inguinal hernia repair, the number of patients with mesh infections is gradually increasing. However, there is a lack of studies assessing the quality of life of patients after the removal of late-onset infected meshes in open inguinal hernias. The aim of this study was to analyse and assess the quality of life, pain severity and anxiety of patients after late-onset infection mesh removal following open inguinal hernioplasty.

METHODS

Data from 105 patients admitted to our hospital from January 2014 to January 2019 who developed delayed mesh infection after open tension-free inguinal hernia repair were retrospectively analysed. 507 patients without mesh infection after open inguinal hernioplasty were included as cross-sectional controls. The baseline data of the two groups were matched for propensity score matching (PSM) with a caliper value of 0.05 and a matching ratio of 1:1. Patients are followed up by telephone or outpatient consultations for 3 years to assess quality of life, pain and anxiety after removal of the infected mesh.

RESULTS

The 105 patients who developed late-onset mesh infection after inguinal hernia repair had a mean age of 64.07 ± 12.90 years and a mean body mass index (BMI) of 24.64 ± 2.67 (kg/m2). The mean follow-up time was 58 months and 10.5% (10/105) of the patients were lost to follow-up. At the 3-year follow-up there was one case of hernia recurrence and five cases of mesh reinfection. The patients' quality of life scores, pain scores and anxiety scores improved after surgery compared to the preoperative scores (all p < 0.01).

CONCLUSION

Patients with late-onset mesh infection after inguinal hernioplasty showed an improvement in quality of life, pain and anxiety compared to preoperative after removal of the infected mesh. Mesh-plug have a higher risk of mesh infection due to their poor histocompatibility and tendency to crumple and shift.

What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up

PURPOSE

Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty.

METHODS

Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3 years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale.

RESULTS

Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58 months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12 months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life.

CONCLUSIONS

Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.