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A PROSPECTIVE RANDOMIZED CLINICAL

TRIAL COMPARING LIGHTWEIGHT AND


HEAVYWEIGHT POLYPROPYLENE MESHES IN
ENDOSCOPIC TOTALLY EXTRAPERITONEAL
GROIN HERNIA REPAIR

P.G Scholar: Dr. Faisal Masoodi

Guide: Dr. Farooq Reshi


Professor of Surgery

BACKGROUND
In the contemporary era Hernia
repair surgery has become almost
synonymous with mesh hernioplasty
Focus of research has shifted to
effect of mesh make on the
outcomes of the repair

BACKGROUND
This has led to the establishment of two different mesh
concepts:

The newer Lightweight Mesh


The conventional Heavyweight Mesh

HEAVYWEIGHT MESH
Heavy weight meshes have been
designed to guarantee a maximum
mechanical stability
Made with thick polymer fibres, small
pores,(<1mm), a high tensile
strength and large surface area.
Weight is about 72 g/m

Lightweight Mesh
Lightweight meshes are designed to
mimic the physiology of abdominal
wall and groin region
Made with small polymer fibres, large
pores(>1mm) and a high flexibility.
Weight is about 36 g/m

Putative Advantages of Lightweight


Mesh
Lesser
Better

incidence of Groin pain

integration into the abdominal

wall
Decreased

Lower

post operative morbidity

incidence of complications

Pitfalls
Concerns about increased
recurrence rate
Handling characteristics
Financial aspects

Aim of our study


To compare the outcomes after

endoscopic TEP groin hernia repair


using Lightweight or Heavyweight
Meshes

Outcome Endpoints

Chronic Groin pain; defined as pain


persisting more than 6 months after
surgery.

Hernia Recurrence; presence of a


recurrent hernia confirmed clinically as
well as radiologically.

Secondary Outcome Measures


Operative time
Postoperative pain on days 0, 1 and
7 (VAS scores)
Return to normal daily activities
Testicular pain
Seromas

Patients and Methods


The Study was carried over a period of one and a
half years in the Postgraduate Department of
Surgery Government Medical College, Srinagar
at S.M.H.S. Hospital.
Patients planned for Laparoscopic T.E.P. repair of
groin hernias were divided into two groups by
computer generated random number table.
Patients in Group 1 underwent mesh
hernioplasty using Heavyweight (Prolene)
mesh whereas in Group 2 Lightweight
(Ultrapro) meshes was used.

EXCLUSION CRITERIA

Patients having a recurrent hernia


Patients with complicated hernias
Patients with symptomatic bladder
outflow obstruction
Patients having some connective tissue
disorder
Patients with contraindications to
General Anesthesia and Laparoscopic
surgery

Methodology
Patients were evaluated on OPD
basis
Admitted one day prior to surgery
Discharged on second or third post
operative day

Follow up
Patients were followed up for a
period of 18 months
They were evaluated for presence of
groin pain and hernia recurrence

RESULTS AND OBSERVATIONS

Age
LWM Group

HWM Group

16
15

16

13

14

12
12
10
No of Patients
8
6
4

3
2

2
0
35-45

46-55

56-65
Age in Years

66-75

Sex distribution
34
35

31

30
25
LWM Group
20

HWM Group

15
10
5

0
Male

Female

Presenting Symptoms
25

25

22

20
15
9

10

LWM
Group

5
3

5
0
Painless

Heaviness

Intermittent Pain

HWM
Group

Recurrence Rate
2
2
1.8
1.6
1.4
1.2

1
0.8
0.6
0.4
0.2
0

0
6 Months

12 Months

18 Months

LMW Group
HMW Group

Chronic Groin Pain


LMW Group

HMW Group

6
6

5
4

4
3

2
1
0

6 Months

12 Months

18 0Months

Operative Time
LMW Group

HWM Group

25
20

21

20
15
15
11
9
10
4
5

0
85-95

96-105
Time in Min

106-115

Operative Time
101
100
99
98
97
96
95
94
93
92
91

HWM

Lightweight Mesh

Heavyweight Mesh

Average V.A.S Scores


5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0

LWM
HWM

DAY 0

DAY 1

DAY 7

Testicular pain
32

35

29
30
25
LMW

20

HMW

15
10
5
0

Present

Absent

Summary And Conclusions


Lightweight Meshes offer Many
advantages in terms of:

Decreased Chronic Groin Pain

Reduced Post Operative Morbidity

Less Restriction Of Abdominal Wall Mobility

Summary And Conclusions


Our study did not show any
significant difference in recurrence
rates.
Yet for larger hernias Lightweight
Meshes should be used with caution

U
O
Y
K
N
A
H
T

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