Lightweight Mesh Research Articles

Chronic Groin Pain Following Lichtenstein Mesh Hernioplasty for Inguinal Hernia. Is It a Myth, How True is It?

Going through the article titled “chronic groin pain following Lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?”, was a treat to read that such an important aspect of a routine surgery has been addressed to, which usually is forgotten in this very common surgical procedure. It is good to see such an astonishing amount of cases being performed i.e. 470 cases which almost reaches to two cases per day considering only <300 working days a year in Indian scenario which is land of festivals. We wanted to clarify that in the material and methods it has been mentioned that patients were followed up at 3 months, 6 month, 1 year and 2 year after surgery. Since the study period was from 01 Feb. 2006 to 29 Feb. 2008 which constitutes only two years, then how is it possible that many patients reached the end point described in material and method. Even if we consider the date of paper submission as last date of study i.e. November 2008 only those cases which were operated before November 2006 would have been followed up for 2 years postoperatively , which would amount to almost one third of the total patients only. Why we are stressing on this is that the frequency of chronic groin pain reported by the author of 0.78% is extremely low compared to range of 0% to 37% of patients undergoing conventional hernia repair [1]. Johann Cunningham et al noted 12% incidence of moderate or severe pain one year after open hernia surgery [2]. Having said that, there are also series which have reported very low rates as well. Sergio Alfieri et al observed chronic severe pain in only 0.5% of patients at 1-year follow-up [3]. This is paramount in saying that if there is such a low incidence of chronic groin pain with polypropylene mesh than where is the need for all the light weight meshes which are being propagated. This low rate reported is tremendous in that we should recommend the technique of surgery which has been used by the author and should standardize the procedure Electronic supplementary material The online version of this article (doi:10.1007/s12262-010-0147-8) contains supplementary material, which is available to authorized users.

IEEE 802.15.5 WPAN mesh standard-low rate part: Meshing the wireless sensor networks

This paper introduces a new IEEE standard, IEEE 802.15.5,which provides mesh capability for wireless personal area network (WPAN) devices. The standard provides an architectural framework enabling WPAN devices to promote interoperable, stable, and scalable wireless mesh topologies. It is composed of two parts: low-rate WPAN mesh and high-rate WPAN mesh. In this paper, we present only low-rate WPAN mesh because it is designed to support wireless sensor networks. IEEE 802.15.5 low-rate part is a light-weight scalable mesh routing protocol that caters well to the requirements of resource-constrained wireless sensor networks. By binding logical addresses to the network topology, IEEE 802.15.5 obviates the need for route discovery. This eliminates the initial route discovery latency, saves storage space and reduces the communication overhead and energy consumption. A distributed link state scheme is further built atop the block addressing scheme to improve the quality of routes, robustness, and load balancing. The routing scheme scales well with regard to various performance metrics. The standard also provides enhanced functions such as multicast, reliable broadcast, power saving, time synchronization, route tracing and portability. We also present the performance evaluation of major functions performed with a 50-nodes tested deployed over a whole floor (100 × 140 ft2) at CUNY Engineering building. The results testify that the IEEE 802.15.5 will serve well for wireless personal area networks and wireless sensor networks.

The Faith of Ilioinguinal Nerve After Preserving, Cutting, or Ligating It: An Experimental Study of Mesh Placement on Inguinal Floor

Postherniorrhaphy chronic pain may be related to the trauma to the regional nerves or prosthetic mesh. This study was aimed to search the objective findings of prosthetic mesh placement on the ilioinguinal nerve in three different nerve treatment patterns with two different mesh types. Thirty New Zealand rabbits were used. Bilateral ilioinguinal nerves were identified. A 2×1 cm standard polypropylene mesh was laid on the nerve on right side, whereas a same sized lightweight polypropylene was applied on the left after three different nerve treatments were carried out. The nerve was completely preserved in the first group [G1], cut by scissors without a further process in the second [G2], and proximal cut end was ligated with 5/0 polyglactin. Three months after the surgery, bilateral nerve samples were taken from the contiguous nerve segment for light microscopy and electron microscopy. Nerve protection could not prevent microscopic changes entirely. Prosthetic mesh itself seemed to cause histopathologic changes. Overall incidence of histopathologic changes in light microscopy, without taking the nerve treatment pattern into account, was somewhat lower at standard mesh side than that of lightweight mesh side. However this difference did not reach the level of significance (P=0.39). When three groups were evaluated in respect to overall nerve damage without paying attention to mesh type, the highest damage rate was observed in G3 (cut and ligate). When each group was compared separately within itself for histopathologic changes, no differences were observed between heavy and light mesh sides in any group. When the microscopic changes were compared in respect to the different nerve treatment patterns on heavyweight mesh side, the rates were 12.5%, 12.5%, and 33.3%, respectively. On lightweight mesh side, all three groups exhibited similar microscopic finding rates, 37.5%, 25.0%, and 33.3%, respectively. Protection of the nerve resulted in virtually zero neuroma formation after two types of mesh use. Surgical trauma to the nerve was observed to have an obvious potential for neuroma formation. Mesh type did not affect the overall neuroma rate within the whole subject pool; both groups displayed same 40% overall neuroma development rate. The neuroma incidence was in 43.8% G2 and 72.2% in G3, however the difference did not attain level of significance (P=0.09). The highest rate was observed when a lightweight mesh was used after dividing and ligating the nerve. Light mesh could not provide a protection in subjects whose nerves were injured during surgery. Ligation of the cut end of the nerve also could not be helpful. Nerve protection still seems to be the best way for a nerve-related complaint-free postoperative period. The merit of nerve end implantation into the muscle should also be reconsidered.

Laparoscopic Inguinal Hernia Repair in Men With Lightweight Meshes May Significantly Impair Sperm Motility

To compare quality of life and fertility aspects after laparoscopic inguinal hernia repair in men using a heavyweight or lightweight mesh. The use of lightweight meshes in laparoscopic inguinal hernia repair could have beneficial effects on quality of life and preservation of the spermatic structures due to a decreased foreign-body reaction. A total of 59 male patients planned for primary, unilateral or bilateral inguinal hernia repair were randomized between a standard polypropylene (Marlex) or lightweight mesh (Vypro II, TiMesh). Main outcome measures were fertility aspects, assessed preoperatively and at 1-year follow-up by semen analysis and scrotal ultrasonography. Secondary outcomes were quality of life (SF-36 and McGill Pain Questionnaire) and recurrence up to 1 year postoperatively. Patients operated on with a VyproII or TiMesh mesh exhibited a decreased sperm motility (vs. preoperatively) compared with Marlex patients, respectively -9.5% and -5.5% versus +2% (P = 0.013). When the results after uni- and bilateral hernia repair were analyzed separately, this difference only remained significant in the bilateral hernia subgroup: -10% for VyproII and -17% for TiMesh versus +1% for Marlex (P = 0.037). Other fertility parameters (sperm concentration, morphology, and alpha-glucosidase level) were unchanged. There were no differences at any study point between the 3 groups regarding quality of life. Only for resumption of sport activities was a small advantage noted for VyproII versus Marlex patients (P = 0.045). After 1 year, no recurrences were observed; 3 patients (6%) complained of chronic disabling pain. Our data suggest that the use of lightweight meshes for laparoscopic inguinal hernia repair in male patients negatively influences sperm motility, without any benefit on quality of life. These alterations might be important in a subgroup of young male patients operated on laparoscopically for a bilateral hernia. This study was registered in the clinicaltrials.gov database (ID number NCT00925067).

Lightweight mesh and noninvasive fixation: an effective concept for prevention of chronic pain with laparoscopic hernia repair (TAPP)

This prospective study aimed to evaluate the impact of transabdominal preperitoneal patch plasty (TAPP) with implantation of a lightweight mesh (<50 g/m²) fixed by fibrin glue on the occurrence of chronic pain and sexual dysfunction in hernia patients. Patients were examined before TAPP, early and late postoperatively. The primary end point of the study was pain-related functional impairment 6 months after the operation as assessed by the validated assessment scale (AAS). For the first time, patients without any pain before surgery were compared with patients experiencing preoperative pain. Furthermore, the patients were asked about the frequency and extent of impairment in their sexual activities. A secondary end point was chronic pain in relation to the type of mesh fixation (glue vs clip). The study criteria was met by 276 patients. The dropout rate after 6 months was 2.9%. Mesh fixation was performed with glue for 212 patients and with clip for 64 patients. Chronic pain with significant impairment of daily activities was experienced by 42% of patients before the operation, which decreased to 8.3% after TAPP. The mean level of impairment, assessed by AAS, decreased from 11.2 preoperatively to 2 postoperatively (p < 0.001). The clip patients had more pain on days 4 and 7 postoperatively (p < 0.05) but not later. A majority of the patients (78%) experiencing pain before the operation were pain free 6 months after TAPP. New pain was seen in 7.4% of the patients but was only mild (numeric analog scale [NAS], 1-3; 78% of patients) or moderate (NAS, 4-6; 11% of patients). The only patient with severe pain (NAS, 8) had a clip fixation. Frequency of sexual dysfunction decreased after TAPP (p < 0.05). The TAPP procedure with implantation of a lightweight mesh fixed by glue is a highly effective option for preventing chronic pain in inguinal hernia repair. Fibrin fixation seems superior to clip fixation during the early postoperative period. However, for confirmation of results, a randomized study is recommended.

Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair

The purported advantage of lightweight large-pore meshes is improved biocompatibility that translates into lesser postoperative pain and earlier rehabilitation. However, there are concerns of increased hernia recurrence rate. We undertook a prospective randomized clinical trial to compare early and late outcome measures with the use of a lightweight (Ultrapro) mesh and heavyweight (Prolene) mesh in endoscopic totally extraperitoneal (TEP) groin hernia repair. A prospective study was performed on 402 patients (191 in Ultrapro and 211 in Prolene group) with bilateral groin hernias who underwent endoscopic TEP groin hernia repair from March 2006 to June 2007. All operations were performed by five consultants following a standardized operative protocol. Chronic groin pain and hernia recurrence were evaluated as primary outcome measures. Secondary outcome measure were early postoperative pain, operative time, number of fixation devices required to fix the mesh, return to normal daily activities of work, seroma, and testicular pain. At 1-year follow-up, incidence in Ultrapro versus Prolene group for chronic groin pain was 1.6% vs. 4.7% (p = 0.178) and recurrence was 1.3% vs. 0.2% (p = 0.078). In Ultrapro versus Prolene group, mean visual analogue score for postoperative pain at day 7 was 1.07 vs. 1.31 (p = 0.00), mean return to normal activities was 1.82 vs. 2.09 days (p = 0.00), and mean number of fixation devices per patient required to fix the mesh was 4.22 vs. 4.08 (p = 0.043). Lightweight meshes appear to have advantages in terms of lesser pain and early return to normal activity. However, more patients had hernia recurrence with lightweight meshes, especially for larger hernias. We surmise that the lightweight meshes have greater tendency to get displaced from their intended position during desufflation at the conclusion of endoscopic TEP repair.

Which mesh for hernia repair?

The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one. We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (www.pubmed.gov). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used the following terms: 'mesh, pore size, strength, recurrence, complications, lightweight, properties'. We also hand-searched the bibliographies of relevant articles and product literature to identify additional pertinent reports. The most important properties of meshes were found to be the type of filament, tensile strength and porosity. These determine the weight of the mesh and its biocompatibility. The tensile strength required is much less than originally presumed and light-weight meshes are thought to be superior due to their increased flexibility and reduction in discomfort. Large pores are also associated with a reduced risk of infection and shrinkage. For meshes placed in the peritoneal cavity, consideration should also be given to the risk of adhesion formation. A variety of composite meshes have been promoted to address this, but none appears superior to the others. Finally, biomaterials such as acellular dermis have a place for use in infected fields but have yet to prove their worth in routine hernia repair.

Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia

This prospective, clinical, randomized, controlled study was performed to define the incidence of chronic pain after total extraperitoneal (TEP) repair with a light-weighted mesh compared with heavyweight mesh in patients with bilateral inguinal hernias. Consecutive patients with bilateral inguinal hernias were recruited for TEP inguinal hernia repair under general anesthesia. Heavyweight mesh was randomly assigned to one side of the groin and lightweight mesh to the other. Patients were followed up regularly for up to 1 year by an independent surgeon who was unaware of the mesh assignment. The postoperative pain score by means of a visual analogue scale (VAS) and other data were recorded. Fifty bilateral TEP hernia repairs were performed between September 2007 and February 2009. Six patients (12%) complained of chronic pain 3 months after the operation. A higher average pain score was observed for the side of hernia repaired by heavyweight mesh compared with lightweight mesh, but the difference was not statistically significant. More patients complained about foreign body sensation on the side repaired with heavyweight mesh (24%) compared with the side with lightweight mesh (8%; P < 0.05). There was no recurrence or need for reintervention for either type of mesh. Lightweight polypropylene mesh may be preferable to heavyweight mesh for TEP inguinal hernia repair because it provides less postoperative foreign body sensation; however, there was no significant difference in the incidence of chronic pain.

The comparison of heavyweight mesh and lightweight mesh in an incisional animal model

An incisional hernia may occur through the incision area following a surgical operation, through the trocar opening and even through drainage exit points. Various synthetic surgical meshes have recently been used for the surgical repair of incisional hernias. In this study, we analysed the burst strength forces of heavyweight mesh and lightweight mesh in an incisional animal model. Following experimental formation of incisional hernias in 32 Wistar albino rats, they were divided into four groups. Polypropylene suture was used for closure of the abdominal incision in Group 1. In Groups 2, 3 and 4, polyester, polypropylene + polyglactin and polypropylene meshes, respectively, were fixed on the surface of the fascia after closing the defects in the rats. Polypropylene and polyester meshes are classified as heavy mesh. Light mesh is composed of a non-absorbable part (polypropylene) and an absorbable part (polyglactin), which will disappear 80 days after implantation. The rats were sacrificed at the end of the experiment. The pullout force of the fascia and meshes were recorded by use of a digital tension meter. The mean pullout forces for Groups 1, 2, 3 and 4 were found to be 123.4 +/- 13.3, 292.33 +/- 17.4, 281.66 +/- 16.3 and 310.60 +/- 26.1 N, respectively. At the end of the experiment, the polypropylene (25 g/cm(2)) present in the lightweight mesh was found to lose only a small percentage of the burst strength compared to the polypropylene (85 g/cm(2)) present in the heavyweight mesh.

Abdominal wall closure by incisional hernia and herniation after laparostoma

As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair.

Randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty

The aim of the present randomised clinical study was to compare the incidence of post-operative chronic groin pain and the feeling of a foreign body after inguinal hernioplasty with lightweight (LW) and heavyweight (HW) mesh, as well as to evaluate the patient's quality of life after inguinal hernia repair. A total of 135 patients were randomised into the HW mesh group (66 patients) and the LW mesh group (69 patients). A tension-free repair using the Lichtenstein technique was performed on all patients. Pain scores were measured on a visual analogue scale. To evaluate the patient's quality of life, the Medical Outcomes Study Short-Form (SF) 36 questionnaire was completed by the patient. There were significantly more patients with pain at rest in the HW mesh group than in the LW mesh group at 6 months follow-up (6.3 vs. 0%, P = 0.038). The feeling of a foreign body at the operation site was experienced by 32.8% of the patients in the HW group and by 20.9% of the patients in the LW group after 6 post-operative months (P = 0.123). There were no significant differences in any dimension of quality of life on the SF36 between the two study groups 6 months after surgery. Our study shows that, compared with HW mesh, LW mesh has some advantages in reducing chronic groin pain at the operation site after inguinal hernioplasty. According to our study, there was no difference in the feeling of a foreign body and in the quality of life between the two study groups.

In Vivo Evaluation of Bacterial Infection Involving Morphologically Different Surgical Meshes

To study the influence of morphology of surgical meshes on the course of bacterial infection under the influence of the host immune system in an in vivo chronic bacterial infection model. The use of prosthetic meshes has increased dramatically the last decades in abdominal wall reconstructive surgery. Whereas infection is becoming a more frequent complication, attention is increasingly drawn to the influence of the surgeon's mesh choice on the course of this complication. Samples of 6 often applied surgical meshes were contaminated with a bioluminescent strain of Staphylococcus aureus and implanted subcutaneously in an immunocompetent BALB/c mouse. The intensity and the spreading of bioluminescence (ie, p/s/cm/sr) were analyzed non-invasively in vivo during a 10-day follow-up period. Over the course of infection, multifilament polypropylene and hydrophobic materials showed a significantly higher persistence of bacteria as well as spreading of infection compared to all other meshes. In contrast, infection resolved in almost all animals with a low-weight polyester mesh. The results of this study are in accordance with circumstantial evidence from limited clinical reports on infection involving surgical meshes and suggest that multifilament and hydrophobic meshes significantly increase bacterial persistence or spreading in the infected area in contrast to monofilament polypropylene and lightweight meshes. Therefore, the surgeon should consider this outcome when choosing a mesh graft for limiting infection in abdominal wall repair.

Minimally Invasive Approaches to Inguinal Hernia Repair

Since their first description in 1992, laparoscopic inguinal hernia repair procedures have been steadily increasing in number. With the standardized teaching of both transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches, laparoscopic repair is now a safe and widespread procedure. The use of different types of prosthetic mesh in inguinal hernia repair has aided the resolution of larger hernias; however, the literature is vast concerning mesh comparisons. We present a systematic review of the current literature on the laparoscopic inguinal hernia technique and prosthetic mesh use. Neither TEP nor TAPP has shown a distinct advantage--both procedures are acceptable. Lightweight mesh is a promising option and biologic mesh is a novel approach; however, both types are lacking randomized, controlled studies. Fixation of prosthetic has been shown by randomized, controlled trials to be unfavorable in most hernia repairs. The addition of prostheses to laparoscopic repair has greatly aided in the treatment of inguinal hernia. However, more prospective, randomized, controlled trials focused on the efficacies of lightweight and biologic meshes and directed toward developing specific guidelines for nonfixation versus fixation need to come to fruition before an operating standard can be set.

Polyglactine/Polypropylene Mesh vs. Propylene Mesh: Is there a need for newer prosthesis in inguinal hernia?

Background/Aim:To compare outcomes of light and heavy weight mesh for repair of inguinal hernia.Materials and Methods:This study was conducted at the Department of Surgery; Lady Reading Hospital, Peshawar from January 1, 2007 to December 31, 2008. Patients were divided into two groups based on the type of mesh implanted for inguinal hernia repair. Group 1 included patients in whom light weight composite (VyproII®) mesh is implanted: Group 2 included patients in whom polypropylene (ProleneR) mesh is implanted. Data concerning the complications and post operative pain in the perioperative and postoperative period were collected and analyzed. Categorical data were presented as percentages with 95% confidence intervals and compared using a χ2test and P<0.05 were considered significant.Results:Following allocation and exclusion of violating cases, 111 patients in group 1 and 138 patients in group 2 were analyzed. The mean age in group 1 was 38.20 ± 13.34 years and in group 2 was 39.55 ± 13.70 (P = 0.434). In group 1, hematoma formation was observed in four cases (3.6%), while it was observed in six cases (4.2%) in group 2 (P = 0.766). During the entire study, ten patients in all developed urinary retention, three of which required transient catheterization. One year post operation, there was a recurrence in only five cases overall, while only two patients complained of pain (P = 0.826).Conclusion:The frequency of postoperative pain and complications in patients was similar in both groups.

Hernia repair: the search for ideal meshes

BackgroundEffective repair of hernia is a difficult task. There have been many advances in hernia repair techniques over the past 50 years, but new strategies must be considered to enhance the success of herniorrhaphy.DiscussionAt the 30th International Congress of the European Hernia Society, nine experts in hernia repair and experimental mesh evaluation participated in a roundtable discussion about today’s unmet needs in hernia repair, including what constitutes an “ideal” hernia repair and the portfolio of “ideal” mesh prostheses. Defining characteristics of lightweight mesh, mesh alternatives, the surgeon’s role in hernia repair, adverse events, the unmet requirements for today’s hernia repair, and optimized animal models were among the topics discussed.ConclusionThe ideal mesh’s construction is still in progress, but greater understanding of its critical characteristics was explored. It is hoped that these suggestions will lead to the development of improved hernia treatments and a maximally effective portfolio of hernia mesh prostheses.

Urinary Stress Incontinence Repair with a Stabilized, Adjustable Minisling (Minitape)

Study Objective: The purpose of this video is to demonstrate a new procedure for urinary stress incontinence repair with a new, stabilized, adjustable minisling (Minitape). This video shows a retropubic approach to implant the 12 centimeter minisling, which is constructed with an ultra lightweight mesh (19 grams square/meter). Minitape shows a high early efficacy rate (97%) with a low complication profile. Postoperative tape adjustment is feasible. Initial results suggest at least benchmark effectiveness associated with full length slings.

Posterior Prolapse Repair Using an Ultra Lightweight Mesh

Posterior Prolapse Repair Using an Ultra Lightweight Mesh

Traditional polypropylene and lightweight meshes in totally extraperitoneal inguinal herniorrhaphy

Background Placement of a prosthetic mesh is integral to successful totally extraperitoneal (TEP) herniorrhaphy. Available meshes have supported the surgical efforts well but search for an ideal mesh continues. Post-herniorrhaphy pain is an index of patient reported outcomes (PRO). The pain is attributable to balloon dissection, cautery, sutures, tackers and prosthesis. Reducing polypropylene content of the mesh is associated with attenuated inflammatory response by the host and improved compliance and comfort. We report the difference in PROs in TEP herniorrhaphy with either heavy polypropylene (PPM) or light weight mesh (LWM) being used for the repair. Patients and methods From June 2004 to December 2005, consecutive candidates for TEP herniorrhaphy were enrolled for this prospective study with an informed consent and compliance to Ethics guidelines. They were operated under general anesthesia (GA) on a day care basis using either PPM or LWM meshes as per the patient's choice. Operative and postoperative PRO were statistically analyzed by an independent doctor using the Microsoft Office Excel 2003. Results One hundred fourteen (84 PPMs and 30 LWMs) TEP herniorrhaphies were performed under GA on 57 male patients without any exclusion, on a day care basis. There was no technical difficulty, operative complications, conversion or prolonged hospital stay in either group. Patients of LWM reported better outcome in regards to pain, NSAID usage, seroma and recurrence. All patients of LWM reported an earlier return to activity. Conclusion Light weight meshes result in comparatively better “patient reported outcomes” in TEP inguinal herniorrhaphy as compared to heavy polypropylene meshes.

Lightweight mesh improves functional outcome in laparoscopic totally extra-peritoneal inguinal hernia repair

Prosthetic mesh reinforcement is standard practice for inguinal hernia repair but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in a lighter weight mesh. The aim of this prospective study was to compare the outcome after laparoscopic totally extra-peritoneal (TEP) inguinal repair using new lightweight or traditional heavyweight mesh performed in a single specialist centre. Between November 2004 and July 2005, 250 patients underwent laparoscopic TEP inguinal repair using either lightweight (Ultrapro, 30 g/m(2)) or heavyweight (Prolene, 100 g/m(2)) mesh. Follow-up data was obtained using case note review and telephone-based questionnaire. Patients were followed up within the early and late post-operative periods to assess any changes in outcome. Follow-up information was obtained for 188 (75%) out of 250 patients. There was no difference between lightweight and heavyweight groups in the incidence or severity of pain/discomfort at mean 4 and 15 months follow-up. There was significantly less interference with physical activity at short and long term follow-up in the lightweight group, in particular lifting (9% vs 21% at mean 4 months, Mann-Whitney U, P = 0.024), walking (1% vs 11% at mean 15 months, Mann-Whitney U, P = 0.006) and vigorous activities (7% vs 19% at mean 15 months, Mann-Whitney-U, P = 0.012). There was no significant difference in awareness of mesh or stiffness in the groin. Laparoscopic TEP inguinal hernia repair with a lightweight mesh improves functional outcome in the short and long term. There was significantly less interference with all aspects of physical activity with the lightweight mesh. Pain in both groups was very mild, highlighting the benefits of laparoscopic surgery.

Fixation of mesh to the peritoneum using a fibrin glue: investigations with a biomechanical model and an experimental laparoscopic porcine model

In recent years, the use of fibrin glue has become an established practice in several areas of surgical treatment. For example, fibrin glue is used increasingly as an alternative method for mesh fixation in hernia surgery, significantly helping to reduce the incidence of chronic pain. The experiments in this study were aimed at elucidating the extent to which tack- or suture-based permanent fixation can be replaced by fixation with fibrin glue for laparoscopic intraperitoneal repair of abdominal wall hernias. In an initial series of experiments conducted with a biomechanical model, the strength of the fibrin glue for fixation of lightweight mesh (TiMesh light) to muscle tissue was compared with its strength of fixation to the peritoneum. In a second series of experiments, mesh was laparoscopically implanted in an established porcine model. Fibrin glue was used for mesh fixation in six animals. Laparoscopic exploration and explantation of the meshes were conducted after 4 months. Planimetric analysis was performed to investigate adhesion and shrinkage of the mesh surface. The strength of fibrin glue for fixation of mesh to the peritoneum was significantly less than for its fixation to muscle tissue (11.86 N vs. 47.88 N; p = 0.001). Three of the implanted meshes were not completely integrated, and two of these were dislocated. On the average, adhesions were seen on 16% of the mesh surfaces. The mesh shrinkage rate was 24.2%. Mesh fixation alone to the undamaged peritoneum in the intraperitoneal region cannot be recommended because of the risk for dislocation. Additional fixation using sutures, tacks, or both is needed until the mesh material is completely integrated.