Lightweight Mesh Research Articles

Randomized Clinical Trial Comparing Low Density versus High Density Meshes in Patients with Bilateral Inguinal Hernia

We present a randomized clinical trial to compare postoperative pain, complications, feeling of a foreign body, and recurrence between heavyweight and lightweight meshes in patients with bilateral groin hernia. Sixty-seven patients with bilateral hernia were included in our study. In each patient, the side of the lightweight mesh was decided by random numbers table. Pain score was measured by visual analogue scale, on 1st, 3rd, 5th, and 7th postoperative day, and one year after the surgery. There were no statistically significative differences between both meshes in postoperative complications. About differences of pain average, there were statistically significant differences only on the 1st postoperative day (P <0.01) and the 7th postoperative day (P <0.05). In the review after a year, there were no statistically significative differences in any parameter. In our study, we did not find statistically significative differences between lightweight and heavyweight meshes in postoperative pain, complications, feeling of a foreign body, and recurrence, except pain on 1st and 7th postoperative day.

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PD17-03 MATCHED PAIR ANALYSIS COMPARING HEAVY WEIGHT VERSUS LIGHTER WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse II1 Apr 2017PD17-03 MATCHED PAIR ANALYSIS COMPARING HEAVY WEIGHT VERSUS LIGHTER WEIGHT WIDE PORE POLYPROPYLENE MESH FOR ROBOTIC SACROCOLPOPEXY Robert Carey, Ali Harris, Maximilian Carey, and Karim Ghazli Robert CareyRobert Carey More articles by this author , Ali HarrisAli Harris More articles by this author , Maximilian CareyMaximilian Carey More articles by this author , and Karim GhazliKarim Ghazli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.850AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES All FDA approved wide pore polypropylene Y-mesh grafts available for robotic sacrocolpopexy have variance in the mesh weight, pore size, thickness, surface area ratio and suture pull out strengths. In this study we evaluated results observed for robotic sacrocolpopexy performed with two separate wide pore polypropylene Y meshes that differ markedly in their physical properties. METHODS Data is collected from an IRB approved prospectively maintained retrospective database of robotic sacrocolpopexy cases performed at an 836 bed tertiary care hospital by a single surgeon. Using analysis matched for covariates of BMI, POP-Q stage, surgeon, and previous attempts at repair, we evaluated whether the weight of the Y-mesh influenced the anatomic outcome and rate of de novo SUI at two year follow-up. RESULTS Between 2011 and 2016, a total of 175 patients underwent robotic sacrocolpopexy for POP-Q Stage IV VVP. 50 patients undergoing repair with a heavy mesh weight (52 g/m2, 527 microns thick, and a suture pull out strength of 18.3 N) were matched to 50 patients undergoing repair with a lighter weight mesh ( 25 g/m2, 200 microns thick, and suture pull out strength of 23.3 N). At two year follow-up, anatomic success for apical prolapse was 100% and 2 patients (4%) in each group were found to have residual Grade 2 anterior prolapse and 2 patients (4%) in each group found to have Grade 2 posterior prolapse. De novo SUI was found in 5 patients (10%) in the heavy mesh group and 4 patients (8%) in the lighter mesh group. All de novo SUI patients did not have a mid urethral sling, MUS, placed at the time of the procedure. There was one mesh erosion in the light weight mesh group in a salvage patient that underwent concomitant pre-existing mesh removal at the time of surgery. CONCLUSIONS Although the two Y-meshes are markedly different in their weight, surface area, thickness and suture pullout strength, there was no observed significant difference in the anatomic success of repair, the rate of de novo stress urinary incontinence or mesh erosion. The rates of de novo SUI seen in this study, have led us to perform a MUS procedure at the time of sacrocolpopexy for all Grade IV prolapse patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e353-e354 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Robert Carey More articles by this author Ali Harris More articles by this author Maximilian Carey More articles by this author Karim Ghazli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Mesh fixation with glue versus suture for chronic pain and recurrence in Lichtenstein inguinal hernioplasty.

Chronic pain following mesh-based inguinal hernia repair is frequently reported, and has a significant impact on quality of life. Whether mesh fixation with glue can reduce chronic pain without increasing the recurrence rate is still controversial. To determine whether tissue adhesives can reduce postoperative complications, especially chronic pain, with no increase in recurrence rate, compared with sutures for mesh fixation in Lichtenstein hernia repair. We searched the following electronic databases with no language restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL; issue 4, 2016) in the Cochrane Library (searched 11 May 2016), MEDLINE Ovid (1986 to 11 May 2016), Embase Ovid (1986 to 11 May 2016), Science Citation Index (Web of Science) (1986 to 11 May 2016), CBM (Chinese Biomedical Database), CNKI (China National Knowledge Infrastructure), VIP (a full-text database in China), Wanfang databases. We also checked reference lists of identified papers (included studies and relevant reviews). We included all randomised and quasi-randomised controlled trials comparing glue versus sutures for mesh fixation in Lichtenstein hernia repair. Cluster-RCTs were also eligible. Two review authors extracted data and assessed the risk of bias independently. Dichotomous outcomes were expressed as odds ratio (OR) with 95% confidence intervals (CI). Continuous outcomes were expressed as mean differences (MD) with 95% CIs. Twelve trials with a total of 1932 participants were included in this review. The overall postoperative chronic pain in the glue group was reduced by 37% (OR 0.63, 95% CI 0.44 to 0.91; 10 studies, 1418 participants, low-quality evidence) compared with the suture group. However, the results changed when we conducted subgroup analysis with regard to the type of mesh. Subgroup analysis of included studies using lightweight mesh showed the reduction of chronic pain was less profound and insignificant (OR 0.77, 95% CI 0.50 to 1.17). Subgroup analysis of included studies using heavyweight mesh resulted in a significant benefit from the fixation with glue (OR 0.38, 95% CI 0.17 to 0.82).Hernia recurrence was similar between the two groups (OR 1.44, 95% CI 0.63 to 3.28; 12 studies, 1932 participants, low-quality evidence). Fixation with glue was superior to suture regarding duration of the operation (MD -3.13, 95% CI -4.48 to -1.78; 9 studies, 1790 participants, low-quality evidence); haematoma (OR 0.52, 95% CI 0.31 to 0.86; 10 studies, 1384 participants, moderate-quality evidence); and recovery time to daily activities (MD -1.26, 95% CI -1.89 to -0.63; 3 studies, 403 participants, low-quality evidence).We also investigated adverse events. There were no significant differences between the two groups. For superficial wound infection pooled analyses showed OR 1.23, 95% CI 0.37 to 4.11; 7 studies, 763 participants (low-quality evidence); for mesh/deep infection OR 0.67, 95% CI 0.16 to 2.83; 8 studies, 1393 participants (low-quality evidence). Furthermore, we investigated seroma (a postoperative swelling caused by fluid) (OR 0.83, 95% CI 0.51 to 1.33); and persisting numbness (OR 0.81, 95% CI 0.57 to 1.14).Finally, six trials involving 1009 participants reported postoperative length of stay, resulting in non-significant difference between the two groups (MD -0.12, 95% CI: -0.35 to 0.10)Due to the lack of data, it was impossible to draw any distinction between synthetic glue and biological glue.Eight out of 12 trials showed high risk of bias in at least one of the investigated domains. Two studies were quasi-randomised controlled trials and the allocation sequence of one trial was not concealed. Nearly half of the included trials either did not provide adequate information or had high risk of bias regarding blinding processes. The risk of bias for incomplete outcome data of all the included studies varied from low to high risk of bias. Two trials did not report on some important outcomes. One study was funded by the manufacturer producing the fibrin sealant. Therefore, according to the 'Summary of findings' tables, the quality of the evidence (GRADE) for the outcomes is moderate to low. Based on the short-term results, glue may reduce postoperative chronic pain and not simultaneously increase the recurrence rate, compared with sutures for mesh fixation in Lichtenstein hernia repair. Glue may therefore be a sensible alternative to suture for mesh fixation in Lichtenstein repair. Larger trials with longer follow-up and high quality are warranted. The difference between synthetic glue and biological glue should also be assessed in the future.

Physical structure and mechanical properties of knitted hernia mesh materials: A review

Mesh implantation for hernia repair is one of the common surgical techniques. The goal of this review is to highlight the basic requirements of mesh in order to select the most appropriate hernia mesh considering mesh type, physical properties and mechanical properties. Textile warp-knitted synthetic meshes have significantly decreased recurrence rate of hernia. Polypropylene light weight mesh with antimicrobial coating is taking attention of researchers due to its improved compliance, infection resistance, hydrophobicity, inert nature and strong material. Composite meshes have better tissue incorporation, reduced shrinkage and improved mechanical properties. The mesh porosity is an important factor to predict the biocompatibility of all meshes. Usually, large pore size meshes are better than small pore size meshes because of their flexibility, decreased shrinkage, reduced scar bridging and increased tissue ingrowth. All synthetic and composite meshes have higher strength than the human abdominal wall. Mesh type, mesh structure, mechanical properties and mesh implantation techniques are important factors for hernia repair. It is critical to understand the physical structure and mechanical properties of mesh material in relation to human abdominal wall. Moreover, mesh surface functionalization and grafting with plasma is a new development technique to enhance the loading of antimicrobial agent for the prevention of mesh infection.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study.

PurposeProsthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair.MethodsForty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated.ResultsThere were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up.ConclusionPartially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Efficacy and safety of a novel partially absorbable mesh in totally extraperitoneal hernia repair.

PurposePartially absorbable mesh has been introduced and used for inguinal hernia repair for the purpose of minimizing pain and improving abdominal wall compliance. In this study, we evaluate the efficacy and safety of ProFlex mesh, a partially absorbed mesh with new structural architecture.MethodsWe retrospectively reviewed 64 cases of totally extraperitoneal herniorrhapy (TEP) from January 2013 to December 2014 for their clinical features, including operation time, pain, postoperative complications, and recurrence.ResultsThere were no significant differences in operation time, hospital stay, postoperative pain, or complications between the 28 patients who received the ProFlex mesh and the 36 who received nonabsorbable lightweight mesh, although one patient who received the nonabsorbable had a recurrence during follow-up. There were differences in operation time, complications, and hospital stay according to the surgeon's previous operation volume.ConclusionThis study showed that there were significant differences in the fixation strength of different polypropylene meshes in combination with various fibrin glues. ProFlex, a partially absorbable mesh with new architecture, was feasible and safe in TEP.

Long-Term Assessment of Surgical and Quality of Life Outcomes Between Lightweight (ULTRAPRO®) and Heavyweight (Standard 3DMax™) Mesh in Laparoscopic Inguinal Hernia Repair

Long-Term Assessment of Surgical and Quality of Life Outcomes Between Lightweight (ULTRAPRO®) and Heavyweight (Standard 3DMax™) Mesh in Laparoscopic Inguinal Hernia Repair

Prospective, multi-institutional surgical and quality-of-life outcomes comparison of heavyweight, midweight, and lightweight mesh in open ventral hernia repair

BackgroundMesh choice in open ventral hernia repair (OVHR) remains controversial. Our aim was to analyze prospective outcomes among heavyweight, midweight, and lightweight (LW) mesh. MethodsA study of the International Hernia Mesh Registry was performed for OVHR. Operative details, complications, recurrence, and quality of life (QOL) at 1, 6, 12, 24, and 36 months were evaluated. ResultsThere were 549 OVHRs, 99 using heavyweight, 262 midweight, and 188 LW mesh. Heavyweight group had larger defects (P ≤ .008). Midweight patients had fewer superficial surgical site infections (P = .04) and shorter LOS (P < .0001). Recurrence rates were equal (6.1% vs 6.1% vs 8.0%; P = .71). After controlling for surgical location, component separation, and preoperative pain with multivariate analysis, LW mesh was associated with an overall worse QOL at 6 months and pain at 1 year. ConclusionsMW mesh had fewer superficial surgical site infections and shorter LOS. After controlling for potential confounding variables, LW mesh had a worse QOL at 6 and 12 months.

Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: A CONSORT-prospective, randomized, clinical trial.

The relationship between mesh weight and host tissue reaction has, so far, not been fully investigated. Lightweight meshes (LWM) are thought to give less inflammatory response compared with heavyweight meshes (HWM). The present study is a randomized, controlled, double-blind clinical trial performed in 61 patients who underwent an elective inguinal hernioplasty. The primary outcome of the study was to investigate the relationship between total amount of prosthetic material (polypropylene), immunological reaction, and oxidative stress. The study was double-blinded. Sixty-one patients were recruited for the study and randomly assigned to 2 groups (groups A and B). Levels of inflammation markers (interleukin-6 [IL-6] and tumor necrosis factor-α [TNF-α]) and oxidative stress markers (reduced glutathione [GSH] and lipid hydroperoxides [LOOH]) were determined preoperatively and after undergoing inguinal hernioplasty (after 6, 72, and 288 hours), respectively, with LWM and HWM. There was no significant difference in IL-6 levels between HWM and LWM (P = 0.3, 0.7, 0.8 after 6, 72, and 288 hours, respectively). A statistically significant difference was found after 72 hours for TNF-α (P = 0.01), for GSH after 6 hours (P < 0.01), and after 6 and 72 hours for LOOH (P = 0.05, 0.01, respectively). Oxidative stress occurred at earlier time points and was pore accentuated HWM versus LWM and prodromal to TNF-α increase.Also, in randomized clinical trial, the use of LWM gives advantages in terms of less inflammatory response when compared with HWM. Moreover, there is a significant higher oxidative stress after implantation of HWM. The intensity of oxidative stress seems to be strongly related to the amount of implanted polypropylene. (Trial registration number: NCT01090284).

Factors predicting chronic pain after open mesh based inguinal hernia repair: ​A prospective cohort study

IntroductionChronic postherniorrhaphy pain is the foremost setback of today's inguinal hernia repair. Finding predictors for it affects implants, operative techniques and allows for preventive measures. MethodsProspectively collected data from 932 outpatient open inguinal hernia operations between 2003 and 2010 were subjected to regression analysis. Visual analogue scale score (VAS) at least a year after operation and a measurement of chronic pain at one year were the target variables. ResultsChronic pain was present in 99 (11.5%) patients one year after operation. Independent predictors for the occurrence of chronic pain were positively recurrence (Odds ratio, OR 6.77 vs. no recurrence, P = 0.005), complication (OR 5.16 vs. no complication, P = 0.002), mid-density mesh (OR 2.28 vs. lightweight mesh, P = 0.012), higher preoperative VAS score (OR 1.15, P = 0.006) and negatively higher age (OR 0.98, P = 0.027).Predictors for a higher postoperative VAS score were recurrence (regression coefficient, RC, 1.49 vs. no recurrence, P = 0.001), complication (RC 0.76 vs. no complication, P = 0.016), heavyweight mesh (RC 0.50 vs. lightweight mesh, P = 0.046) and higher preoperative VAS level (RC 0.10, P < 0.001). ConclusionsRecurrence, complication, mesh weight, preoperative VAS score and age are predictors for the occurrence chronic pain after open mesh based inguinal hernia repair. Recurrence, complication, mesh weight and preoperative VAS score are predictors of postherniorrhaphy VAS level.

Heavy-weight (prolene) mesh versus light-weight (ultrapro) mesh in laparoscopic transabdominal preperitoneal inguinal hernia repair

Context Laparoscopic repair of inguinal hernia has gained its place in the general practice; however, meshes such as prolene were the same as those used for open repair. New types of light-weight meshes such as ultrapro may be associated with less complications and rates of recurrence. Aim The study aimed to compare the outcomes of transabdominal preperitoneal inguinal hernia repair using heavy-weight (prolene) mesh versus the light-weight (ultrapro) mesh. Settings and design This is a prospective randomized comparative study. Materials and methods Sixty patients were recruited for this study. Fifteen patients were operated by transabdominal preperitoneal inguinal hernia repair using the light-weight mesh and 45 patients were operated using the heavy-weight mesh. The patients were surveyed for postoperative complications, such as seroma, obstruction, pain, and recurrence. Statistical analysis Continuous variables were expressed as mean and SD. Categorical variables were expressed as frequencies and percentage. Results There was no statistically significant difference between the two groups regarding the postoperative complications or recurrence rates. The light-weight meshes were superior regarding the first 24 h pain and pain after 1 week, 1, 6, and 12 months with early return to physical activity in comparison with the heavy-weight meshes. Conclusion Light-weight meshes are superior to the heavy-weight meshes in respect to the occurrence of pain and early return to work, yet with comparable results regarding the postoperative complications and recurrence rates.

Long-term Results of a Randomized Double-blinded Prospective Trial of a Lightweight (Ultrapro) Versus a Heavyweight Mesh (Prolene) in Laparoscopic Total Extraperitoneal Inguinal Hernia Repair (TULP-trial).

The aim of the randomized clinical trial was to compare the 2 years of clinical outcomes of a lightweight (Ultrapro) vs a heavyweight (Prolene) mesh for laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Lightweight meshes reduce postoperative pain and stiffness in open anterior inguinal hernia repair. The discussion about a similar benefit for laparoscopic repair is ongoing, but concerns exist about higher recurrence rates. Between March 2010 and October 2012, male patients who presented with a primary, reducible unilateral inguinal hernia who underwent day-case TEP repair were eligible. Outcome parameters included chronic pain, recurrence, foreign body feeling, and quality of life scores. During the study period, 950 patients were included. One year postoperatively the presence of relevant pain (Numeric Rating Score 4-10) was significantly higher in the lightweight mesh group (2.9%) compared with the heavyweight mesh group (0.7%) (P = 0.01), and after 2 years this difference remained significant (P = 0.03). There were 4 (0.8%) recurrent hernias in the heavyweight mesh group and 13 (2.7%) in the lightweight group (P = 0.03). No differences in foreign body feeling or quality of life scores were detected. In TEP hernia surgery, there was no benefit of lightweight over heavyweight meshes observed 2 years postoperatively.

Prospective analysis of postoperative outcomes – immediate / delayed in patients undergoing Lichtenstein’s open inguinal hernioplasty using Vypro® vs Prolene® mesh

As we advance towards improving inguinal hernia repair our goals remain to decrease the immediate post-operative complications like pain and seroma formation; and at the same time preventing long term complications like chronic groin pain and hernia recurrence. We present in our study comparision of outcomes in the immediate and late post-operative phase of 50 patients [25 - prolene® and 25 - vypro®] who underwent lichtenstein’s inguinal hernia. Our results did encourage the lightweight mesh like vypro® in the immediate post-operative phase but did not give any major difference between the meshes in the long term complications or outcomes of hernia repair. Our observations were similar to other studies done comparing the various mesh used for hernia repair.

Lightweight vs Midweight Polypropylene Mesh in 948 Open Ventral Hernia Repairs (OVHR)

Lightweight vs Midweight Polypropylene Mesh in 948 Open Ventral Hernia Repairs (OVHR)

Iridescence Print: Robotically Printed Lightweight Mesh Structures

This article presents a novel robot-based 3D printing technique for the automated fabrication of nonstandard large-scale lightweight structures. The approach offers unique advantages over conventional approaches to 3D printing: It can be performed freely in space, it is scalable, and it enables the fabrication of structures from a filament 3D printing process. A first full-scale demonstration case—the architectural installation Iridescence Print—was exhibited at the Palais de Tokyo in Paris. Based on ongoing research and teaching activities, the installation exemplifies a new area of research in the field of 3D printing: robotically printed lightweight mesh structures.

Comparison of Outcome between Light weight Mesh &amp; Heavy Weight Mesh in Lichtenstein Groin Hernia Repair

Comparison of Outcome between Light weight Mesh &amp; Heavy Weight Mesh in Lichtenstein Groin Hernia Repair

Report of 12 years experience in the surgical treatment of 286 paraesophageal hernias

In contrast to axial hiatus hernias, paraesophageal hernias are rare but can lead to chronic iron deficiency anemia and severe acute complications. Treatment is manifold and consistent standards are lacking. The aim of this study was to describe our experiences of 286 patients with paraesophageal hernias, who underwent surgery from 2003 to 2014 at a tertiary referral center. The study was particularly concerned with morbidity, mortality, quality of life and recurrence rates. In 12 years a total of 286 paraesophageal hernias were surgically treated, 255 with a minimally invasive procedure and 31 with an open approach. In 138 patients (48 %) the suture-based hiatoplasty was reinforced by means of a lightweight mesh, which was fixed with fibrin glue in 90 cases. Abdominal fixation of the stomach consisted of a gastropexy and anterior (n = 244) or posterior (n = 42) fundoplication. Complications arose in 8.4 % of the patients. The mean hospital stay was 5.3 (± 2.8) days for elective surgery and 24.7 (± 17.8) days for emergency operations. The gastrointestinal quality of life index according to Eypasch significantly increased from mean preoperative values of 92.8 (± 22.5) to 109.6 (± 20.2) in the postoperative course (p < 0.001). Of the patients 20 (7 %) suffered a recurrence requiring surgery, including 7 early and 13 late recurrences. During the immediate postoperative period radiographically detected recurrences were promptly revised. The strategy of late recurrences in the long-term course was based on patient symptoms and asymptomatic hernias were treated conservatively while symptomatic hernias were surgically treated. Symptomatic late recurrences developed in 4.6 % of the patients, including 7.4 % (11 out of 148) without and 1.4 % (2 out of 138) with primary mesh repair. The repair of paraesophageal hernias in 286 patients provided excellent patient satisfaction and symptom improvement with low perioperative morbidity and mortality. Mesh reinforcement reduced the recurrence rate. The quality of life index is a suitable clinical course parameter for evaluation of paraesophageal hernias.

Titanium versus absorbable tacks comparative study (TACS): a multicenter, non-inferiority prospective evaluation during laparoscopic repair of ventral and incisional hernia: study protocol for randomized controlled trial

BackgroundLaparoscopic repair of ventral and incisional hernias has gained popularity since many studies have reported encouraging results in terms of outcomee and recurrence. Choice of mesh and fixation methods are considered crucial issues in preventing recurrences and complications. Lightweight meshes are considered the first choice due to their biomechanical properties and the ability to integrate into the abdominal wall. Titanium helicoidal tacks still represent the “gold standard” for mesh fixation, even if they have been suggested to be involved in the genesis of post-operative pain and complications. Recently, absorbable tacks have been introduced, under the hypothesis that there will be no need to maintain a permanent fixation device after mesh integration. Nevertheless, there is no evidence that absorbable tacks may guarantee the same results as titanium tacks in terms of strength of fixation and recurrence rates. The primary end point of the present trial is to test the hypothesis that absorbable tacks are non-inferior to titanium tacks in laparoscopic incisional and ventral hernia repair (LIVHR) by lightweight polypropylene mesh, in terms of recurrence rates at 3-year follow-up. Surgical complications, post-operative stay, comfort and pain are secondary end points to be assessed.Methods/DesignTwo hundred and twenty patients with ventral hernia will be randomized into 2 groups:Group A (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by titanium tacks;Group B (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by absorbable tacks.DiscussionA few retrospective studies have reported similar results when comparing absorbable versus non-absorbable tacks in terms of intraoperative and early post-operative outcomes. These studies have the pitfalls to be retrospective evaluation of small series of patients, and the reported results still need to be validated by larger series and prospective studies.The aim of the present trial is to investigate and test the non-inferiority of absorbable versus non-absorbable tacks in terms of hernia recurrence rates, in order to assess whether the use of absorbable tacks may achieve the same results as non-absorbable tacks in mid-term and long-term settings.Trial registration numberNCT02076984: 5 June 2014 (ClinicalTrials.gov)Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0779-x) contains supplementary material, which is available to authorized users.

The Prosthetic Materials in Hernia Repair

Even though the number and variety of materials used in hernia operations have increased considerably, the ideal mesh is yet to be produced. The aim of this study is to review the current information on available meshes. Literature on the presently used grafts and the means of their usage were reviewed through Medline-PubMed. Large pores of lightweight grafts were shown to decrease the risk of infection and shrinkage. There is still no proven superiority in terms of the materials that are aimed for intra-abdominal use and have one side covered with adhesion preventers. The results prove that hernia surgeries using mesh (graft) provide a better outcome compared with conventional repair methods. Fiber type, tensile strength, and pore width have been indicated as the most important factors in mesh choice as well as determinants of biocompatibility. It is understood that the required tensile strength is less than expected, and lightweight meshes are superior in providing flexibility and comfort. In inguinal hernia repair, lightweight meshes suitable for the hernia type and lightweight or biomeshes that are absorbable in the presence of an infection are considered to be the better choice. Composite meshes that have one side covered in adhesion-preventive barriers are asserted to be the proper fit for the intraabdominal procedures. (JAREM 2015; 5: 1-5)