title: Randomised clinical trial: conventional Lichtenstein vs. hernioplasty with self-adhesive mesh in bilateral inguinal hernia surgery.
abstract: OBJECTIVE
  To compare the results of conventional Lichtenstein hernioplasty with polypropylene mesh (PLP) with a lightweight self-adhesive mesh (Parietene Progrip®; Covidien, Dublin, Ireland) (PPG) used in patients with bilateral inguinal hernia.
  
  
  METHODS
  Randomised clinical trial with 89 patients with a minimum follow-up of 1 year. Every patient had bilateral inguinal hernia and had both prostheses implanted randomly, one on each side. Early postoperative and chronic pain was evaluated using the visual analogue scale. Also recurrence rate and subjective evaluation of patients were analysed.
  
  
  RESULTS
  Pain in the early postoperative period was inferior on the side where the self-adhesive mesh had been implanted (6.12 vs. 6.62, p=0.005 during the 1st postoperative day; 2.12 vs. 2.62, p=0.001 during the 7th postoperative day). Differences disappeared with the long-term evaluation (0.71 vs. 0.98, p=0.148 1 year after the surgery). The operative time was significantly shorter on the PPG mesh side (24.37 ± 5.1 in case of the PPG mesh and 29.66 ± 5.6 in case of the PLP mesh, p<0,001). Recurrence occurred in seven patients (7.8%), six of them (6.7%, CI 3.0-14.4) on the PPG mesh side and one (1.1%, CI 0.2-7.8) on the PLP side. These differences were not statistically significant (p=0.125) CONCLUSIONS: Although hernioplasty with self-adhesive mesh reduced early postoperative pain, this reduction was clinically irrelevant and it had no influence on chronic pain. There was a trend towards a higher recurrence rate when self-adhesive meshes were used, and although in this study differences were not statistically significant they should be confirmed in later studies using larger samples. Surgical procedures that do not need fixing sutures are promising, but further studies are needed before they become the gold standard of inguinal hernia repair.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Porrero
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Castillo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez-Zapata
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: María T
authors.initials: MT
authors.lastname: Alonso
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain. oscarcanovalderrama@hotmail.com.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cano-Valderrama
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Quirós
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Sol
authors.initials: S
authors.lastname: Villar
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ramos
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sánchez-Cabezudo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Bonachia
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Santa Cristina, Calle Maestro Amadeo Vives 2, 28009, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marcos
authors.affiliation: Servicio de Medicina Preventiva y Salud Laboral, Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: Brígido
authors.initials: B
authors.lastname: Pérez
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D011126:Polypropylenes; D012008:Recurrence; D013526:Surgical Mesh; D014014:Tissue Adhesives; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes; D014014:Tissue Adhesives
keywords: Bilateral hernia; Chronic pain; Hernia recurrence; Inguinal hernia; Polypropylene mesh; Postoperative complications; Self-adhesive mesh