• R Bittner, C-G Schmedt, B J Leibl, and J Schwarz.
• Department of General-, Visceral-, and Vascular-Surgery, Hernia Center, EuromedClinic Fürth, Europaallee 1, 90763 Fürth, Germany. bittnerfamilie@web.de
• World J Surg. 2011 Aug 1;35(8):1791-7.

BackgroundToday the main goals of inguinal hernia repair are maximum postoperative comfort and a minimal rate of chronic pain. This randomized trial compares these parameters after laparoscopic hernia repair (TAPP) using an extralight titanized polypropylene mesh (ELW group) TiMesh(®) 16 g/m(2) without any fixation with those using a standard heavyweight mesh (HW) Prolene 90 g/m(2) fixed in a standardized way with two absorbable sutures.MethodsThree hundred patients with an inguinal hernia and a defect diameter ≤3 cm were included in the trial. Patients were assessed for pain, foreign body sensation, and physical activities preoperatively, early postoperatively, at 4 weeks, 6 months, and 1 year by questionnaire and were examined clinically. Postoperatively, seroma formation was measured by ultrasound.ResultsOne year after TAPP, the frequency of chronic pain was not greater than 3%, with no difference between the two mesh groups; in no patient was intensity of pain higher than VAS 40. In the early postoperative period, 40% of the patients in the titanized ELW group needed pain medication compared with 52.7% in the HW group (P = 0.0378). Foreign body sensation was not different between the groups but there was significantly less impairment of physical activities (P = 0.0425) and seroma production (P = 0.0415) in the titanized ELW group compared to the HW group in the early postoperative period.ConclusionUse of titanized ELW mesh for laparoscopic hernia repair did not affect the rate of chronic pain but it seems to improve early postoperative convalescence. Its use without any fixation can be recommended in TAPP for inguinal hernia patients with a defect size ≤3 cm.

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