Lightweight versus Heavyweight mesh for open repair of inguinal hernia

Abstract

Background Open repair of inguinal hernia with mesh is associated with a decreased risk of recurrence compared to hernia repair without mesh. However, the use of traditional heavyweight (HWM) polypropylene mesh in hernia repair has raised concerns about the higher incidence of postoperative chronic groin pain, persistent groin discomfort, foreign body sensations, testicular atrophy and impaired sensations in the groin. Lightweight mesh (LWM) is composed of a reduced component of reactive biomaterial and is considered an innovative measure to lessen the long term consequences of the mesh repair of inguinal hernia. Objectives The objective of this review is to systematically analyse the randomised, controlled trials (RCTs) to compare the effectiveness of LWM versus HWM in patients undergoing open inguinal hernia repair. Search methods The Cochrane Colorectal Cancer Group (CCCG) Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (Issue 1, 2012), MEDLINE (until March 2012), EMBASE (The Intelligent Gateway to Biomedical & Pharmacological Information until March 2012), and Science Citation Index Expanded (SCI-E until March 2012) using the medical subject headings (MeSH) terms were searched without date, language or age restrictions. Selection criteria RCTs comparing the effectiveness of LWM versus HWM in patients undergoing open inguinal hernia repair. Data collection and analysis At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. This data was further confirmed by the third review author to check the accuracy. Main results Fourteen published articles on eleven RCTs encompassing 2589 patients undergoing open inguinal hernia repair either using LWM or HWM were retrieved from the electronic databases. There were 1282 patients in the LWM group and 1307 patients in the HWM group. Statistically, there was no difference between LWM and HWM in terms of duration of operation, postoperative complications, the risk of hernia recurrence and the risk of developing testicular atrophy. LWM was associated with lower postoperative pain score, early return to work and daily activities. In addition, LWM was associated with the reduced risk of developing chronic groin pain and the reduced risk of developing other groin symptoms such as groin discomfort, sensory impairment, regional hard feelings, point tenderness and foreign body sensations. Authors' conclusions LWM may not increase the risk of inguinal hernia recurrence. LWM seems to be associated with the reduced risk of developing chronic groin pain and other symptoms such as groin discomfort, sensory impairment, regional hard feelings, point tenderness and foreign body sensations. These outcomes should better be judged after long-term follow up and therefore, LWM may only be considered a viable alternative to HWM in open inguinal hernia repair instead of recommending its routine use.