Composite polypropylene mesh versus lightweight polypropylene mesh: The TAPP repair for laparoscopic inguinal hernia repair

Abstract

Aims and Objectives: To determine the frequency of complications and pain scores post-operatively following TAPP (Transabdominal Pre-peritoneal)repair for inguinal hernia, comparing lightweight polypropylene versus the composite polypropylene mesh. Materials and Methods: This study was conducted at Lady Reading Hospital, Peshawar, from December 1, 2007, to November 30, 2011. Group A included all those patients with inguinal hernia that were operated using the TAPP method and extraperitoneal placement of the lightweight polypropylene mesh, whereas group B comprised of those patients that were placed a composite polypropylene mesh (VYPRO II R ). A pro forma was prepared to record all the relevant data such as the NYHUS classification of the type of hernia, the post-operative pain scale score, and the complications that included seroma formation, testicular pain and atrophy, preoperative injuries, surgical emphysema, adhesion obstruction, mesh infection, wound infection, and perioperative mortality. The planned sequence of follow-up after discharge of the patient was at 1 week, 1month, 3 months, 6 months, and one year. Data were analyzed using SPSS R for Windows version 13.0. Results: A total of 192 patients were operated, equally divided between both groups. The VYPRO II R group had a higher number of direct hernias and the operative time was also much less but this was not statistically significant (P=0.91). The mean hospital stay was slightly higher in the polypropylene group but that was also not significant (P=0.89). The frequency of seroma formation was higher in the polypropylene group (6.25%) and majority of these patients from both groups had larger scrotal hernias (P=0.34). The most significant finding in this study was the frequency of chronic pain with a visual analogue score of >3(1-10) after the six-month period was significantly higher in the polypropylene group (P=0.02). The recurrence rate was comparable in both groups with 3 patients in group B(P=0.62). Conclusions: No difference in the frequency of recurrence was observed over a one-year follow-up period but significant pain scores were observed in the polypropylene group. Studies with longer follow-up to rule the rate of recurrence in composite meshes will determine its benefit over the lightweight polypropylene meshes.