A single-surgeon randomized trial comparing three composite meshes on chronic pain after Lichtenstein hernia repair in local anesthesia.
BACKGROUND
Chronic pain may be a long-term problem related to operative trauma and mesh material in Lichtenstein hernioplasty.


METHODS
Inguinal hernioplasty was performed under local anesthesia in 228 patients (232 hernias) in day-case surgery by the same surgeon and exactly by the same surgical technique. The patients were randomized to receive either a partly absorbable polypropylene-polyglactin mesh (Vypro II(R) 50 g/m(2), 79 hernias), a lightweight polypropylene mesh (Premilene Mesh LP(R) 55 g/m(2), 75 hernias) or a conventional densely woven polypropylene mesh (Premilene(R) 82 g/m(2), 78 hernias). Pain, patients discomfort and recurrences of hernias were carefully followed at days 1, 7, 1 month, 1 and 2 years after surgery.


RESULTS
The duration of operation (29-33 min) and the amount of local anesthetic (55-57 ml) were similar in the three groups. Two wound infections and four hematomas were detected with no difference between the meshes. Immediate pain reaction up to 1 month was statistically equal among the three meshes. After 2 years of follow-up, there were five recurrences (two in the Vypro group, one in the Premilene LP and two in the Premilene). A feeling of a foreign body, sensation of pain and patient's discomfort were similar with all meshes.


CONCLUSIONS
There was no difference of pain and quality of life among a conventional polypropylene mesh, lightweight mesh or partly absorbable mesh in 2 years of follow-up, when the same surgeon operated on all patients with exactly the same technique.
Paajanen
H
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Department of General Surgery, The Central Hospital of Mikkeli, Porrassalmenkatu 35-37, 50100 Mikkeli, Finland. hannu.paajanen@esshp.fi
D000772:Anesthesia, Local / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis*; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome