Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair

TLDR

Chronic pain after inguinal hernia repair is a long‑term problem that may arise from technical fixation issues rather than mesh material itself. This randomized trial compared 12‑month pain outcomes between a partially absorbable lightweight mesh and a non‑absorbable heavyweight mesh. Patients completed pain questionnaires at 1, 3 and 12 months and underwent a clinical examination at 12 months. At 12 months, the lightweight mesh group experienced significantly less pain (39.5% vs 51.6%) but a higher recurrence rate (5.6% vs 0.4%), with most recurrences occurring at a single centre.

Abstract

Abstract Background Severe chronic pain is a long-term problem that may occur after inguinal hernia repair. The aim of this randomized study was to compare pain of any severity at 12 months after inguinal hernia repair with a partially absorbable lightweight mesh (LW group) or with a non-absorbable heavyweight mesh (HW group). Methods Patients were assessed for pain at 1, 3 and 12 months by questionnaire, and were examined clinically at 12 months. Results Some 321 patients were included in an intention-to-treat analysis, 162 in the LW group and 159 in the HW group. At 12 months, significantly fewer patients in the LW group than in the HW group had pain of any severity: 39·5 versus 51·6 per cent (difference—12·1 (95 per cent confidence interval—23·1 to—1·0) per cent; P = 0·033). The recurrence rate was higher in the LW group (5·6 versus 0·4 per cent; P = 0·037). Five of eight recurrences in LW group were associated with a single participating centre. Conclusion Use of lightweight mesh was associated with less chronic pain but an increase in hernia recurrence after inguinal hernia repair. The latter may be related to technical factors associated with fixation of such meshes rather than any inherent defect in the mesh.