title: Three-month results of the effect of Ultrapro or Prolene mesh on post-operative pain and well-being following endoscopic totally extraperitoneal hernia repair (TULP trial).
abstract: BACKGROUND
  Recurrence rates after inguinal hernia repair have been reduced to a few per cent, since mesh repair has become standard of care. Lightweight meshes reduce post-operative pain and stiffness in open anterior repair, but for endoscopic repair, the discussion about this benefit is ongoing. This study was done to analyse the effects of lightweight mesh versus heavyweight mesh following endoscopic totally extraperitoneal (TEP) hernia repair.
  
  
  METHODS
  In a single-centre double-blindly randomized clinical trial, 950 patients with unilateral primary inguinal hernia were randomized to undergo endoscopic TEP using either an Ultrapro(®) or a Prolene(®) mesh. Data were collected by validated questionnaires at day 1, day 7, after 6 weeks and after 3 months, and clinical assessment was performed after 3 months. The presence of groin pain after 3 months, defined as an NRS score >3, was evaluated as the primary outcome measure. Secondary outcomes were foreign body feeling and the impact of pain and foreign body feeling on daily activities.
  
  
  RESULTS
  At 3-month follow-up, the incidence of pain (NRS 4-10) was 2 versus 0.9 % in the lightweight and heavyweight mesh group, respectively (p = 0.17). Pain interfered with daily activities in 1.7 % of the lightweight and 1.5 % of heavyweight group. In the lightweight group, 20 % of patients reported a foreign body feeling versus 18 % in the heavyweight group (p = 0.62). No differences between the groups were observed regarding time to return to work, interference with sports and sexual activities, testicular pain and ejaculatory pain. Severe preoperative pain (OR 2.01, 95 % CI 1.21-3.35, p = 0.01) was the only independent predictor of any post-operative pain after 3 months.
  
  
  CONCLUSIONS
  Three months after TEP inguinal repair, there were no significant differences between lightweight and heavyweight mesh use regarding the incidence of pain, foreign body feeling or any other endpoint.
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands. iburgmans@diakhuis.nl.
authors.forename: J P J
authors.initials: JP
authors.lastname: Burgmans
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: C E H
authors.initials: CE
authors.lastname: Voorbrood
authors.affiliation: Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Schouten
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Smakman
authors.affiliation: Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Elias
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Clevers
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: P H P
authors.initials: PH
authors.lastname: Davids
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: E J M M
authors.initials: EJ
authors.lastname: Verleisdonk
authors.affiliation: Department of Geriatric Medicine, Diakonessenhuis Utrecht/Zeist, Zeist, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Hamaker
authors.affiliation: Department of Surgery, UMCU, Utrecht, The Netherlands.
authors.forename: R K J
authors.initials: RK
authors.lastname: Simmermacher
authors.affiliation: Department of Surgery, Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Room: Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van Dalen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011126:Polypropylenes; D011474:Prosthesis Design; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D011126:Polypropylenes
keywords: Chronic groin pain; Heavyweight mesh; Lightweight mesh; Mesh awareness; Quality of life; TEP repair