Polypropylene versus Polyester Mesh for Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative Study

Mike Ralf Langenbach, Stefan Sauerland

Department of Surgery II, Helios St. Elisabeth Klinik Oberhausen, University of Witten/Herdecke, Oberhausen, Germany.
Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany.

DOI: 10.4236/ss.2013.41005                

Abstract

Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene, Covidien, France), and a polyester mesh (Parietex, Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on day 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.

Keywords

TAPP; Inguinal Hernia; Polypropylene; Polyester; Mesh; Pain

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. R. Siewert, “Wandel der Eingriffshaufigkeiten in der Allgemeinchirurgie,” Der Chirurg, Vol. 64, 1990, pp. 1297-1300.
[2]	B. C. Shah, M. R. Goede, R. Bayer, S. L. Buettner, S. J. Putney, C. L. McBride and D. Oleynikov, “Does Type of Mesh Used Have an Impact on Outcomes in Laparoscopic Inguinal Hernia?” American Journal of Surgery, Vol. 198, No. 6, 2009, pp. 759-764. doi:10.1016/j.amjsurg.2009.04.025
[3]	M. S. Sajid, N. Ladwa, L. Kalra, K. Hutson, P. Sains and M. K. Baig, “A Meta-Analysis Examining the Use of Tacker Fixation versus No-Fixation of Mesh in Laparoscopic Inguinal Hernia Repair,” International Journal of Surgery, Vol. 10, No. 5, 2012, pp. 224-231.
[4]	D. Leung and M. B. Ujiki, “Minimally Invasive Approaches to Inguinal Hernia Repair,” Journal of Long-Term Effects of Medical Implants, Vol. 20, No. 2, 2010, pp. 105-116. doi:10.1615/JLongTermEffMedImplants.v20.i2.30
[5]	L. Matheron, A. Disset, F. Navarro and C. Partensky, “Prosthetic Mesh for Hernia Repair: Which Mesh for Which Indication? Analysis of the Committee for the Assessment of Devices and Health Technologies of the French National Authority for Health (HAS). Assessment of Prosthetic Meshes for Hernia Repair,” Journal de Chirurgie, Vol. 146, No. 5, 2009, pp. 449-457. doi:10.1016/j.jchir.2009.09.012
[6]	B. Klosterhalfen, U. Klinge, B. Hermanns and V. Schumpelick, “Pathology of Traditional Surgical Nets for Hernia Repair after Longterm Implantation in Humans,” Der Chirurg, Vol. 71, No. 1, 2000, pp. 43-51. doi:10.1007/s001040051011
[7]	R. Bittner, K. Kraft, C. G. Schmedt, J. Schwarz and B. Leibl, “Risks and Benefits of Laparoscopic Hernioplasty (TAPP)—5 Years of Experience in 3400 Hernia Repairs,” Der Chirurg, Vol. 69, 1998, pp. 854-858. doi:10.1007/s001040050500
[8]	EU Hernia Trialists Collaboration, “Repair of Groin Hernia with Synthetic Mesh: Metaanalysis of Randomized Controlled Trials,” Annals of Surgery, Vol. 235, No. 3, 2002, pp. 322-332. doi:10.1097/00000658-200203000-00003
[9]	D. Weyhe, O. Belyaev, C. Müller, K. Meurer, K. H. Bauer, G. Papapostolou and W. Uhl, “Improving Outcomes in Hernia Repair by the Use of Light Meshes—A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature,” World Journal of Surgery, Vol. 31, No. 1, 2007, pp. 234-244. doi:10.1007/s00268-006-0123-4
[10]	K. Junge, U. Klinge, R. Rosch, B. Klosterhalfen and V. Schumpelick, “Functional and Morphologic Properties of a Modified Mesh for Inguinal Hernia Repair,” World Journal of Surgery, Vol. 26, No. 12, 2002, pp. 1472-1480. doi:10.1007/s00268-002-6444-z
[11]	M. R. Langenbach, J. Schmidt, B. Ubrig and H. Zirngibl, “Sixty-Month Follow-Up after Endoscopic Inguinal Hernia Repair with Three Types of Mesh. A Prospective Randomized Trial,” Surgical Endoscopy, Vol. 22, No. 8, 2008, pp. 1790-1797. doi:10.1007/s00464-008-9863-6
[12]	J. R. Eriksen, I. Gogenur and J. Rosenberg, “Choice of Mesh for Laparoscopic Ventral Hernia Repair,” Hernia, Vol. 11, No. 6, 2007, pp. 481-492. doi:10.1007/s10029-007-0282-8
[13]	G. Champault, C. Bernard, N. Rizk and C Polliand, “Inguinal Hernia Repair: The Choice of Prosthesis Outweights That of Technique,” Hernia, Vol. 11, No. 2, 2007, pp. 125-128. doi:10.1007/s10029-006-0179-y
[14]	D. Weyhe, O. Belyaev, C. Müller, K. Meurer, K. H. Bauer, G. Papapostolou and W. Uhl, “Improving Outcomes in Hernia Repair by the Use of Light Meshes—A Comparison of Different Implant Constructions Based on a Critical Appraisal of the Literature,” World Journal of Surgery, Vol. 31, No. 1, 2007, pp. 234-244. doi:10.1007/s00268-006-0123-4
[15]	K. Junge, U. Klinge, R. Rosch, B. Klosterhalfen and V. Schumpelick, “Functional and Morphologic Properties of a Modified Mesh for Inguinal Hernia Repair,” World Journal of Surgery, Vol. 26, No. 12, 2002, pp. 1472-1480. doi:10.1007/s00268-002-6444-z
[16]	D. Weyhe, I. Schmitz, O. Belyaev, R. Grabs, K. M. Müller, W. Uhl and V. Zumtobel, “Experimental Comparison of Monofile Light and Heavy Polypropylene Meshes: Less Weight Does Not Mean Less Biological Response,” World Journal of Surgery, Vol. 30, No. 8, 2006, pp. 1586-1589. doi:10.1007/s00268-005-0601-0
[17]	H. Scheidbach, C. Tamme and A. Tannapfel, “In Vivo Studies Comparing the Biocompatibility of Various Polypropylene Meshes and Their Handling Properties during Endoscopic Total Extraperitoneal (TEP) Patchplasty: An Experimental Study in Pigs,” Surgical Endoscopy And Other Interventional Techniques, Vol. 18, No. 2, 2004, pp. 211-220. doi:10.1007/s00464-003-8113-1
[18]	R. Horstmann, M. Hellwig, C. Classen, S. Rottgermann and D. Palmes, “Impact of Polypropylene Amount on Functional Outcome and Quality of Life after Inguinal Hernia Repair by the TAPP Procedure Using Pure, Mixed and Titanium-Coated Meshes,” World Journal of Surgery, Vol. 30, No. 9, 2006, pp. 1742-1749. doi:10.1007/s00268-005-0242-3
[19]	T. Schmidtbauer, R. Ladurner, K. K. Hallfeldt and T. Mussack, “Heavy-Weight versus Low-Weight Polypropylene Meshes for Open Sublay Mesh Repair of Incisional Hernia,” European Journal of Medical Research, Vol. 10, No. 6, 2005, pp. 247-253.
[20]	J. E. Morrison and V. R. Jacobs, “Laparoscopic Preperitoneal Inguinal Hernia Repair Using Preformed Polyester Mesh without Fixation: Prospective Study with 1-year Follow-Up Results in a Rural Setting,” Surgical Laparoscopy Endoscopy & Percutaneous Techniques, Vol. 18, No. 1, 2008, pp. 33-39. doi:10.1097/SLE.0b013e318157b155
[21]	B. Ramshaw, F. Abiad, G. Voeller, R. Wilson and E. Mason, “Polyester (Parietex) Mesh for Total Extraperitoneal Laparoscopic Inguinal Hernia Repair: Initial Experience in the United States,” Surgical Endoscopy, Vol. 17, No. 3, 2003, pp. 3498-3501.
[22]	P. T. Nguyen, J. R. Asarias and L. M. Pierce, “Influence of a New Monofilament Polyester Mesh on Inflammation and Matrix Remodeling,” Journal of Investigative Surgery, Vol. 25, No. 5, 2012, pp. 330-339.
[23]	T. Poghosyan, N. Veyrie, N. Corigliano, N. Helmy, S. Servajean and J.-L. Bouillot, “Retromuscular Mesh Repair of Midline Incisional Hernia with Polyester Standard Mesh: Monocentric Expierience of 261 Consectutive Patients with a 5-Year Follow-Up,” World Journal of Surgery, Vol. 36, No. 4, 2012, pp. 782-790. doi:10.1007/s00268-012-1443-1