title: Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation.
abstract: BACKGROUND
  Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit(®) mesh by W. L. Gore & Associates.
  
  
  METHODS
  This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1 year.
  
  
  RESULTS
  Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6 weeks (P = 0.035), 6 months (P = 0.023), and 1 year (P = 0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group.
  
  
  CONCLUSIONS
  Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair.
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria ; Paracelsus Private Medical University , Salzburg , Austria.
authors.forename: René H
authors.initials: RH
authors.lastname: Fortelny
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration , Vienna , Austria.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Petter-Puchner
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration , Vienna , Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria.
authors.forename: Christopher
authors.initials: C
authors.lastname: May
authors.affiliation: Trauma Surgery, Landeskrankenhaus St. Pölten , St. Pölten , Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pospischil
authors.affiliation: Department of General, Visceral and Oncological Surgery, Wilhelminenspital , Vienna , Austria.
authors.forename: Karl
authors.initials: K
authors.lastname: Glaser
keywords: Lichtenstein hernia repair; fibrin glue; monofilament PTFE; postoperative pain; quality of life