title: Total extraperitoneal hernioplasty: does the long-term clinical course depend on the type of mesh?
abstract: BACKGROUND
  Implantation of alloplastic material has become a standard surgical procedure in inguinal hernia repair. The properties of different meshes are discussed as determinants of postoperative outcome. The aim of this study was to comparatively evaluate long-term results after total extraperitoneal hernioplasty (TEP) with a heavyweight polypropylene mesh (PP) and a lightweight polypropylene-polyglactin composite mesh (PP-PG) in a large patient population.
  
  
  METHODS
  The study included patients who underwent TEP for elective repair of uni- or bilateral inguinal hernias between June 1997 and October 2004. We used a heavyweight PP mesh from June 1997 to February 2001 and a lightweight PP-PG mesh from March 2001 to October 2004. Patient data were evaluated by a prospective online registry, and long-term results were assessed by standardized ad hoc questionnaires after a minimum follow-up of 12 (12-103) months.
  
  
  RESULTS
  Five hundred twenty-two patients aged 18-87 years underwent surgical repair of 655 inguinal hernias, and 370 (70.8%) were evaluated. TEP was performed with PP mesh in 192 cases and with PP-PG mesh in 169 cases. Nine patients died during follow-up; 14.6% (PP) versus 20.1% (PP-PG) patients complained of mild pain, and 8.9% (PP) versus 5.3% (PP-PG) patients reported moderate to severe pain (P > 0.05). Mild dysesthesias occurred in 13.5% of the PP group and 11.8% of the PP-PG group (P = 0.63). Moderate to severe dysesthesias were reported by 6.8% with a heavyweight mesh and by 3.0% with a lightweight mesh (P = 0.10). There were no significant differences with regard to the patients' postoperative return to normal daily activities. The recurrence rate was 5.2% with a PP mesh and 1.8% with a PP-PG mesh (P = 0.08).
  
  
  CONCLUSIONS
  The long-term results after TEP showed no difference between PP and PP-PG meshes with regard to chronic pain, chronic dysesthesias, postoperative daily activities, and recurrence rates.
authors.affiliation: Department of General, Vascular, and Thoracic Surgery, Charité-Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany. johannes.lauscher@charite.de
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Lauscher
authors.forename: Kamal
authors.initials: K
authors.lastname: Yafaei
authors.forename: Heinz J
authors.initials: HJ
authors.lastname: Buhr
authors.forename: Jörg P
authors.initials: JP
authors.lastname: Ritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011098:Polyglactin 910; D011126:Polypropylenes; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012042:Registries; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes; D011098:Polyglactin 910