The effects of onlay titanium-coated mesh on recurrence, foreign body sensation and chronic pain after ventral hernia repair

Impact of titanium-coated polypropylene mesh on functional outcome and quality of life after inguinal hernia repair

Objective

This study aims to compare the clinical outcomes of complications, quality of life, and chronic pain between titanium-coated polypropylene mesh and polypropylene mesh after Lichtenstein or TAPP surgery.

Methods

A retrospective cohort study was conducted, involving patients who underwent inguinal hernia repair using Timesh light®, Optilene LP®, or 3DMax™ meshes between January 2020 and May 2022. Based on the surgical method, patients were divided into Lichtenstein and TAPP groups, and further categorized according to the type of mesh used. The primary endpoints assessed postoperative complications, postoperative pain, and postoperative quality of life. Secondary endpoints included postoperative sensation in the surgical area and postoperative recurrence rate.

Results

A total of 180 Lichtenstein procedures and 478 TAPP procedures were included in the analysis after propensity score matching. The findings revealed that patients with titanium-coated polypropylene mesh did not exhibit significant advantages in perioperative data. Within three months to one year after TAPP surgery, patients with the titanium-coated polypropylene mesh reported improved foreign body sensation during activities (P = 0.002) and a lower incidence of chronic pain (P = 0.008). However, after one year, these advantages of titanium-coated polypropylene mesh were no longer significant during activity or at rest. In the TAPP group, the titanium-coated polypropylene mesh depicted advantages in the single score of the SF-36 questionnaire.

Conclusions

The utilization of titanium-coated polypropylene mesh resulted in reduced foreign body sensation and chronic pain in activity within one year after TAPP surgery, significantly enhancing certain aspects of the patient's quality of life compared to polypropylene mesh.

What is the ideal mesh location for incisional hernia prevention during elective laparotomy? A network meta-analysis of randomized trials

BACKGROUND

Incisional hernia (IH) represents an important complication after surgery. Prophylactic mesh reinforcement (PMR) with different mesh locations [onlay (OL), retromuscular (RM), preperitoneal (PP), and intraperitoneal (IP)] has been described to possibly reduce the risk of postoperative IH. However, data reporting the 'ideal' mesh location are sparse. The aim of this study was to evaluate the optimal mesh location for IH prevention during elective laparotomy.

METHODS

Systematic review and network meta-analysis of randomized controlled trials (RCTs). OL, RM, PP, IP, and no mesh (NM) were compared. The primary aim was postoperative IH. Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference.

RESULTS

Fourteen RCTs (2332 patients) were included. Overall, 1052 (45.1%) had no mesh (NM) while 1280 (54.9%) underwent PMR stratified in IP ( n =344 pts), PP ( n =52 pts), RM ( n =463 pts), and OL ( n =421 pts) placement. Follow-up ranged from 12 months to 67 months. RM (RR=0.34; 95% CrI: 0.10-0.81) and OL (RR=0.15; 95% CrI: 0.044-0.35) were associated with significantly reduced IH RR compared to NM. A tendency toward reduced IH RR was noticed for PP versus NM (RR=0.16; 95% CrI: 0.018-1.01), while no differences were found for IP versus NM (RR=0.59; 95% CrI: 0.19-1.81). Seroma, hematoma, surgical site infection, 90-day mortality, operative time and hospital length of stay were comparable among treatments.

CONCLUSIONS

RM or OL mesh placement seems associated with reduced IH RR compared to NM. PP location appears promising; however, future studies are warranted to corroborate this preliminary indication.

Transcutaneous Electric Nerve Stimulation Reduces Pathological Sensation of Mesh One Week after Open Inguinal Hernia Surgery: Follow-Up Results from a Randomized, Double Blind and Placebo-Controlled Trial

Background and Objectives: Quality of life (QoL) and chronic pain are important outcomes following hernia surgery. The long-term effects of Transcutaneous Electric Nerve Stimulation (TENS) on postoperative recovery are not well known. In this trial we investigated the role of TENS on QoL and on the incidence of chronic pain following inguinal hernia repair with mesh. Materials and Methods: A total of 80 male patients with elective primary unilateral hernia Lichtenstein repair were randomly allocated to receive TENS or a placebo-TENS procedure. The TENS group received conventional TENS twice a day on the first and second postoperative days. The intensity was set at 0–0.5 mA in the placebo-TENS group. General and hernia-specific QoL, as well as the incidence of chronic pain were assessed using SF-36v2 and the Carolinas comfort scale. Results: Less sensation of mesh was reported by the TENS group patients one week after surgery. At this time point, the mean sensation score was 6.07 ± 8.88 in the TENS group and 14.08 ± 16.67 in the placebo-TENS group (p = 0.029). Although at two days and one week postoperatively, TENS group patients tended to have less pain, less movement restrictions and better overall hernia-specific QoL, the differences were not statistically significant. At 6 months postoperatively, no incidence of chronic pain was found in either the placebo-TENS or TENS group. Conclusions: Conventional TENS applied in the early postoperative period following inguinal hernia repair with mesh was found to reduce mesh-related foreign body sensation one week after surgery. Promising results were also found for other QoL domains.