This article is a collaboration between ľֱ and:
HOUSTON -- Use of self-fixating mesh during laparoscopic inguinal hernia repair (LIHR) did not improve pain-related quality of life in patients when compared with a non-fixating mesh product, a researcher reported here.
Patients receiving self-fixating mesh experienced more pain in the first 48 hours postoperatively than those receiving non-fixating mesh, with no subsequent difference in pain impact (P=0.780) or pain quality (P=0.495) at 3 weeks or 1 year, said John Linn, MD, of NorthShore University Health System in Glenview, Ill.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Additionally, there was no difference in quality of life (QoL) for patients completing 1-year follow-up, he reported during a poster session at the annual .
"There is a newer, self-fixating version of polyester mesh that's been available and we wanted to see if it was as good, better, or not as good as the current version of polyester that we've been using for laparoscopic inguinal hernia repair," Linn explained to ľֱ.
In reviewing the study findings, he noted that "the adhesive component of self-fixing mesh may cause an inflammatory response for the first few days. After two weeks it's completely gone so why the impact is only seen then is not really known, but that's my guess. In the long term there wasn't a difference."
Linn's team conducted a single-blind, randomized controlled trial with 221 patients who had primary unilateral inguinal hernias. Patients were randomized to non-fixating mesh (n=116) or self-fixating mesh (n=105). The mean age (60.1 versus 57.4 years), mean BMI (25.6 versus 26.1), and median symptom duration (2 months for both groups) were similar.
The Surgical Outcomes Measurement System (SOMS) QoL instrument was used to assess pain, fatigue, and physical function preoperatively and at 3 weeks and 1 year after LIHR.
Linn and colleagues found that median operative times (P=0.328) and length of stay (P=0.120) were similar for the self-fixating mesh versus the non-fixating mesh groups.
Patients who received non-fixating mesh recorded significantly better mean SOMS scores, indicating less pain, for each of the first 3 days following surgery.
Narcotic medication use was more common in the self-fixating group (45 versus 35 patients, P=0.022), but there was little difference in the amount or duration of use.
Linn and colleagues also found that more patients in the non-fixating group received tacks (31 versus 16, P=0.018), although the median number of tacks used was similar (5.5 tacks versus 5.1, P=0.464) in patients receiving them. There were zero recurrences.
Looking forward, Linn said, "The next question is what is the long-term follow-up for all of these patients. Not just in the perioperative period but, at one and two years, is there a difference in recurrence or long-term patient-centered outcomes of pain, discomfort, movement limitations."
"The bigger question is patient outcomes, quality of life ... that's where the real areas of improvement can be made if we can find mesh products that cause less pain, less discomfort, less movement," he said.
Both types of mesh used in the study were made by Medtronic.
Primary Source
Society of American Gastrointestinal and Endoscopic Surgeons
Johnson B, et al "Preliminary results of a single-blinded, prospective randomized controlled trial comparing non-fixating vs. self-fixating mesh for laparoscopic inguinal hernia repair" SAGES 2017; Abstract P002.