Polypropylene versus Polyester Mesh for Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative Study

Background: Polypropylene meshes are commonly used in laparoscopic inguinal hernia repair, although they may cause complications. In this prospective study, a polyester mesh was compared to a polypropylene mesh. Methods: Transabdominal preperitoneal (TAPP) laparoscopic repair was performed in 160 consecutive male patients suffering from unilateral inguinal hernia. The first 80 cases received a polypropylene mesh (Parietene, Covidien, France), and a polyester mesh (Parietex, Covidien, France) was implanted in the second half of patients. Both groups were comparable with respect to clinical and demographic variables. Patients rated their pain using the visual analogue scale (VAS), and ultrasonography was performed on postoperative days 1 and 3 to measure seroma formation. Results: The duration of surgery and the length of stay were similar in both groups. Postoperative pain, measured on day 1 and 3, was significantly less in patients who had received a polyester mesh as compared to the polypropylene group. The size of local seroma was also significantly reduced in the polyester group. Complication rates were 10% in the polypropylene and 9% in the polyester group and included one early recurrence in each group. Conclusions: Polyester meshes may be useful in TAPP, as this mesh material produces less foreign body reaction with less seroma formation and lower pain levels than conventional polypropylene.

Urological Affections after Laparoscopic Hernia Repair in Long-Term Follow up

Objectives: Chronic pain is a severe complication of mesh-based inguinal hernia repair. Pain upon ejaculation, testicular touch sensitivity and dysuria are apparent. Regarding the large amount of patients undergoing laparoscopic hernia repair, the problem seems quite evident. In this prospective, clinical, randomized, double-blind study we intended to investigate the biocompatibility of three different meshes and their influence on urological affections after operative procedure. Methods: 180 male patients with primary inguinal hernia undergoing TAPP were randomized for using a heavyweight (108 g/m2), double-filament PP mesh (Prolene, 10 9 15 cm, group A, n = 60), a multifilament, heavyweight variant (116 g/m2) of PP mesh (Serapren, 10 9 15 cm, group B, n = 60), or a composite mesh (polyglactin and PP) (Vypro II, 10 9 15 cm, group C, n = 60). We compared in terms of complications (seromas, recurrence rate), urological affections and life quality (SF-36 Health Survey). The follow-up period was 60 months. Results: Convalescence in group A was slower than in groups B and C: mean-term values of the visual scales for pain development were significantly (p th week postoperatively. There were no significant differences between groups B and C. Beyond the 12th post-interventional week the differences diminished. Conclusions: Independent which kind of mesh was implanted still 5% of patients suffered from urological affections 60 month later.

Loop Ileostomy and Colostomy—A Comparison between Supporting Plastic Rods and Epicutaneous or Subcutaneous Silicon Drains

Purpose: Beside the conventional plastic rods, different techniques and materials have been proposed in the last years to prevent the loop from retraction into the abdominal cavity. The aim of this retrospective comparative study was to assess three different techniques of loop support. Methods: The study included 65 pa- tients who had loop ileostomy or colostomy formed. Depending on the decision of the operating surgeon, one of three techniques was chosen to fixate the stoma loop: an epicutaneous plastic rod (group 1, n = 14), an epicutaneous suture-fixated silicone drain (group 2, n = 27), or a subcutaneous silicone drain (group 3, n = 24). Results: The majority of patients (85%) received loop ileostomy. Pain intensity was significantly (p = 0.0014) different among the three groups. A total of 19 patients (30%) suffered a complication. There was a tendency towards less complications if the stoma was secured by a silicone drain with epicutaneous fixation. Comfort with stoma care was significantly different, with group 3 experiencing the best results. Conclusions: Using a subcutaneously tunnelled silicon drain as a stoma bridge results in less complications, less pain and higher satisfaction as compared to the conventional plastic rod. Conventional plastic rods should be avoided.