Introduction
Chronic pain after hernia repair is a well-known complication and can be expected in 4–6% of patients undergoing transabdominal preperitoneal (TAPP) repair, with deleterious effects on daily activities and quality of life. Mesh-based chronic pain usually results from shrinkage and adhesions formation. Pain can be attributed to the type of the mesh inserted as well as the techniques of its fixation.
Objectives
The authors compare between anatomical mesh and standard flat prolene mesh regarding their effects on chronic postoperative pain. The authors also evaluate fixation using tacks and its effect on chronic postoperative inguinodynia.
Patients and methods
This is a randomized prospective cohort study of 200 patients undergoing TAPP repair with either anatomical meshes or flat prolene meshes. The authors randomized patients to either groups by closed envelop technique. Average age was 34.52 ± 9.63 years, and 83% of patients were males and 17% were females. Patients were evaluated on the seventh day, first month, sixth month, and first year. All patients were evaluated through questionnaires and detailed physical examination. Study outcomes included postoperative pain evaluated through visual analog scale (VAS) scores, seroma formation, and other operative morbidities. The correlation between number of tacks inserted and postoperative pain was also evaluated. Secondary outcomes include mean operative time and mean hospital stay.
Results
Mean VAS scores were statistically lower (<0.05) in anatomical mesh group compared with flat mesh group. This difference started from the first evaluation visit (seventh day) and persisted till the last visit (after 1 year). Seroma formation was comparable between both groups (>0.05). A fair relationship between the number of tacks inserted and incidence of postoperative pain was found (adjusted coefficient of determination, adjusted =0.362). Mean operative time and mean hospital stay were significantly lower in anatomical mesh group (<0.05).
Conclusion
Anatomical meshes reduce the incidence of postoperative inguinodynia. This effect starts early in postoperative period and persists over the first year. Traditional operative metrics as mean hospital stay and operative time were also better in anatomical group without any increase in operative complications.