Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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N.F. Stoikes et al.
Numerous studies have evaluated the differences between conventional
heavyweight (or normal weight) mesh and lightweight mesh and
the development of CGP. Bringman et al. evaluated 600 patients who
underwent hernia repair at 3 years [ 15 ]. Patients were randomized to
have implantation of polypropylene mesh of 80 g/m 2 or a 30 g/m 2 . The
lightweight mesh group was found to have less pain and less sensation
of mesh. The lightweight mesh group was also found to have less
“minor” groin problems. Paajanen et al. reviewed 228 patients who were
randomized to various lightweight and heavyweight mesh options, and
these patients were followed up at 2 years [ 16 ]. There was no difference
in pain, quality of life, sensation of mesh, or hernia recurrences. Page
and O’Dwyer also found no difference in pain scores at one year
between patient groups ( N = 300) who underwent repair with either partially
absorbable mesh or nonabsorbable mesh [ 17 ]. They did find a
significantly higher recurrence rate among patients who had repairs
using the partially absorbable mesh (5.6 vs. 0.7 %). Currently, there are
no strong data to confirm that mesh weight is a contributor to CGP in
inguinal hernia repair.
Fixation
Another cause of chronic pain in inguinal hernia repair may be the
type of fixation used to secure the mesh. There are a wide variety of
options, including sutures (absorbable and permanent), tacks (absorbable
and permanent), and adhesives. These various options apply to both
laparoscopic and open techniques. Referring to open mesh repair, the
TIMELI trial by Campanelli et al. included 319 patients and compared
the use of fibrin sealant for fixation versus sutures [ 18 ]. At 1 year, there
were less disabling complications among patients in the adhesive group,
with less pain at 1 month and 6 months. Meta-analysis by Colvin et al.
also found a reduction in CGP with adhesive use in open inguinal hernia
repair with mesh [ 19 ]. Comparisons of suture material in open inguinal
hernia have been done as well. Paajanen randomized 162 patients to
absorbable (Dexon TM , polyglycolic acid) versus permanent (polypropylene)
suture fixation with Lichtenstein hernia repair [ 20 ]. At 2 years,
there was no difference between the two groups. Twenty-four percent
described “some” pain in follow-up, but over 90 % of patients were
satisfied with their result. In contrast, Jeroukhimov et al. conducted a
single- blinded randomized controlled trial comparing Vicryl ® (polyglactin
910) and polypropylene fixation with a Lichtenstein approach [ 21 ].