Light and heavy mesh deliver similar outcomes and QOL for lap inguinal repair

 

WASHINGTON – The weight of mesh used in laparoscopic inguinal hernia repairs was not a significant factor in postoperative outcomes and quality of life, in a large, long-term study.

“There are approximately 700,000 inguinal hernia repairs annually,” said Steve Groene, MD, of the Carolinas Medical Center, Charlotte, N.C. “The goal of our study was to utilize a large sample size of long-term follow-up and compare surgical and quality of life outcomes between light-weight and heavy-weight mesh in laparoscopic inguinal hernia repairs.”

In their prospective study using a hernia-specific database, Dr. Groene and his associates studied 1,270 patients who had laparoscopic inguinal hernia repair with light-weight (flat sheet) and heavy-weight (3-D) polypropylene mesh from 1999 to May 2015. Patients who underwent repair with light-weight (LW) mesh were significantly younger (P less than .001) and had significantly less comorbidities (P less than .001), specifically diabetes (P = .010), hypertension (P less than .001), and chronic obstructive pulmonary disease (P = .037), than those who received heavy-weight mesh. In terms of operative characteristics, the heavier the mesh, the higher the rate of incarcerated hernia (P less than .001), leading to a higher rate of large defects (P less than .001).

The rates of postoperative complications such as surgical infection, urinary retention, and recurrence in the two groups were similar. Although the LW mesh group had a significantly higher rate of hematoma and seroma, that difference vanished with a multivariate analysis that accounted for confounding factors such as smoking, elective vs. emergent surgery, and surgical technique, Dr. Groene said at the annual clinical congress of the American College of Surgeons.

Quality of life (QOL) was measured with the Carolina Comfort Scale before surgery and at the 2-week, 1-month, 6-month, 12-month, 24-month, and 36-month follow-ups. The investigators looked at pain, movement limitation, and mesh sensation for outcomes and symptoms. There were no other statistically significant differences in QOL between the groups at any of the follow-up time points.

When asked during the discussion about the experience of the investigators in getting patients to continue through a 36-month follow-up, Dr. Groene said that “at 1 month, we were about 60%, [and] at 1 year about 40%; having about 40%-42% of people following up at 1 month is very good.”

Dr. Groene concluded that surgeons should continue to use the type of mesh they feel most comfortable with for laparoscopic inguinal hernia repair and expect to have similar outcomes.

He reported having no relevant financial disclosures.

[email protected]

 

WASHINGTON – The weight of mesh used in laparoscopic inguinal hernia repairs was not a significant factor in postoperative outcomes and quality of life, in a large, long-term study.

“There are approximately 700,000 inguinal hernia repairs annually,” said Steve Groene, MD, of the Carolinas Medical Center, Charlotte, N.C. “The goal of our study was to utilize a large sample size of long-term follow-up and compare surgical and quality of life outcomes between light-weight and heavy-weight mesh in laparoscopic inguinal hernia repairs.”

In their prospective study using a hernia-specific database, Dr. Groene and his associates studied 1,270 patients who had laparoscopic inguinal hernia repair with light-weight (flat sheet) and heavy-weight (3-D) polypropylene mesh from 1999 to May 2015. Patients who underwent repair with light-weight (LW) mesh were significantly younger (P less than .001) and had significantly less comorbidities (P less than .001), specifically diabetes (P = .010), hypertension (P less than .001), and chronic obstructive pulmonary disease (P = .037), than those who received heavy-weight mesh. In terms of operative characteristics, the heavier the mesh, the higher the rate of incarcerated hernia (P less than .001), leading to a higher rate of large defects (P less than .001).

The rates of postoperative complications such as surgical infection, urinary retention, and recurrence in the two groups were similar. Although the LW mesh group had a significantly higher rate of hematoma and seroma, that difference vanished with a multivariate analysis that accounted for confounding factors such as smoking, elective vs. emergent surgery, and surgical technique, Dr. Groene said at the annual clinical congress of the American College of Surgeons.

Quality of life (QOL) was measured with the Carolina Comfort Scale before surgery and at the 2-week, 1-month, 6-month, 12-month, 24-month, and 36-month follow-ups. The investigators looked at pain, movement limitation, and mesh sensation for outcomes and symptoms. There were no other statistically significant differences in QOL between the groups at any of the follow-up time points.

When asked during the discussion about the experience of the investigators in getting patients to continue through a 36-month follow-up, Dr. Groene said that “at 1 month, we were about 60%, [and] at 1 year about 40%; having about 40%-42% of people following up at 1 month is very good.”

Dr. Groene concluded that surgeons should continue to use the type of mesh they feel most comfortable with for laparoscopic inguinal hernia repair and expect to have similar outcomes.

He reported having no relevant financial disclosures.

[email protected]

 

WASHINGTON – The weight of mesh used in laparoscopic inguinal hernia repairs was not a significant factor in postoperative outcomes and quality of life, in a large, long-term study.

“There are approximately 700,000 inguinal hernia repairs annually,” said Steve Groene, MD, of the Carolinas Medical Center, Charlotte, N.C. “The goal of our study was to utilize a large sample size of long-term follow-up and compare surgical and quality of life outcomes between light-weight and heavy-weight mesh in laparoscopic inguinal hernia repairs.”

In their prospective study using a hernia-specific database, Dr. Groene and his associates studied 1,270 patients who had laparoscopic inguinal hernia repair with light-weight (flat sheet) and heavy-weight (3-D) polypropylene mesh from 1999 to May 2015. Patients who underwent repair with light-weight (LW) mesh were significantly younger (P less than .001) and had significantly less comorbidities (P less than .001), specifically diabetes (P = .010), hypertension (P less than .001), and chronic obstructive pulmonary disease (P = .037), than those who received heavy-weight mesh. In terms of operative characteristics, the heavier the mesh, the higher the rate of incarcerated hernia (P less than .001), leading to a higher rate of large defects (P less than .001).

The rates of postoperative complications such as surgical infection, urinary retention, and recurrence in the two groups were similar. Although the LW mesh group had a significantly higher rate of hematoma and seroma, that difference vanished with a multivariate analysis that accounted for confounding factors such as smoking, elective vs. emergent surgery, and surgical technique, Dr. Groene said at the annual clinical congress of the American College of Surgeons.

Quality of life (QOL) was measured with the Carolina Comfort Scale before surgery and at the 2-week, 1-month, 6-month, 12-month, 24-month, and 36-month follow-ups. The investigators looked at pain, movement limitation, and mesh sensation for outcomes and symptoms. There were no other statistically significant differences in QOL between the groups at any of the follow-up time points.

When asked during the discussion about the experience of the investigators in getting patients to continue through a 36-month follow-up, Dr. Groene said that “at 1 month, we were about 60%, [and] at 1 year about 40%; having about 40%-42% of people following up at 1 month is very good.”

Dr. Groene concluded that surgeons should continue to use the type of mesh they feel most comfortable with for laparoscopic inguinal hernia repair and expect to have similar outcomes.

He reported having no relevant financial disclosures.

[email protected]