Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs

被引:37
作者
Akolekar, D. [1 ]
Kumar, S. [1 ]
Khan, L. R. [1 ]
de Beaux, A. C. [1 ]
Nixon, S. J. [1 ]
机构
[1] Univ Edinburgh, Royal Infirm Edinburgh, Dept Surg, Edinburgh EH16 4SA, Midlothian, Scotland
关键词
Inguinal; Hernia; Recurrence; Mesh; Lightweight;
D O I
10.1007/s10029-007-0275-7
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro-Ethicon) for totally extraperitoneal (TEP) inguinal hernia surgery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavyweight mesh during TEP hernia repair. Methods Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identified from the Lothian Surgical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a surrogate for date of recurrence. Results Two hundred and fifty one patients had 371 hernia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically significant differences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. Conclusion In view of increased patient comfort, we continue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhesion.
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页码:39 / 43
页数:5
相关论文
共 19 条
[11]   Chronic pain after laparoscopic and open mesh repair of groin hernia [J].
Kumar, S ;
Wilson, RG ;
Nixon, SJ ;
Macintyre, IMC .
BRITISH JOURNAL OF SURGERY, 2002, 89 (11) :1476-1479
[12]   Recurrence after totally extraperitoneal laparoscopic repair: Implications for operative technique and surgical training [J].
Lamb, A. D. G. ;
Robson, A. J. ;
Nixon, S. J. .
SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, 2006, 4 (05) :299-307
[13]   Open mesh versus Laparoscopic mesh repair of inguinal hernia [J].
Neumayer, L ;
Giobbie-Hurder, A ;
Jonasson, O ;
Fitzgibbons, R ;
Dunlop, D ;
Gibbs, J ;
Reda, D ;
Henderson, W .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (18) :1819-1827
[14]   The totally extraperitoneal approach (TEP) to inguinal hernia repair [J].
Nixon, SJ ;
Kumar, S .
SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, 2005, 3 (04) :281-287
[15]   Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair [J].
O'Dwyer, PJ ;
Kingsnorth, AN ;
Molloy, RG ;
Small, PK ;
Lammers, B ;
Horeyseck, G .
BRITISH JOURNAL OF SURGERY, 2005, 92 (02) :166-170
[16]   Randomized clinical trial of lightweight composite mesh for Lichtenstein inguinal hernia repair [J].
Post, S ;
Weiss, B ;
Willer, M ;
Neufang, T ;
Lorenz, D .
BRITISH JOURNAL OF SURGERY, 2004, 91 (01) :44-48
[17]  
Puccio F, 2005, INT SURG, V90, pS21
[18]   Prosthetic implants for hernia repair [J].
Schumpelick, V ;
Klinge, U .
BRITISH JOURNAL OF SURGERY, 2003, 90 (12) :1457-1458
[19]   Totally extraperitoneal endoscopic inguinal hernia repair (TEP) -: Results of 5,203 hernia repairs [J].
Tamme, C ;
Scheidbach, H ;
Hampe, C ;
Schneider, C ;
Köckerling, F .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2003, 17 (02) :190-195