News Feed Discussions Quality of life – lightweight vs heavyweight mesh

  • Quality of life – lightweight vs heavyweight mesh

    Posted by Good intentions on February 26, 2019 at 7:29 pm

    I’ve come across an interesting article comparing light mesh versus heavy mesh. But it is one of the pay-per-view journals so I can’t see the full paper. The conclusion is that they are both essentially the same. But it’s not clear if either is better than a pure tissue repair. Or even if people were happy with the outcome. Just that they are both either equally good or equally bad. It received an award when the results were presented.

    In this age of “informed consent” shouldn’t these articles be free to the general public? How are we supposed to be informed if the research is held by the mesh repair industry? I can’t afford to buy these articles to see if anything of value is in them. Maybe somebody wants to take a shot and see what the actual quality of life results were.

    Also very interesting that the medical device makers spent thousands or millions, you would expect, “developing” these lightweight materials as a solution for chronic pain and complications. Supposedly with high level research behind the development. But there’s nothing here. Waste of money, waste of time, apparently, but good marketing material to sell more product and look like they are working on solutions to the chronic pain issue. Thousands of surgeons recommending light weight mesh as a preventive measure to chronic pain. Everybody, including the surgeons, has been fooled, apparently. Lightweight mesh looks like a sham.

    https://www.sciencedirect.com/science/article/pii/S0039606018307281

    “Conclusion

    Contoured lightweight mesh and heavyweight mesh in laparoscopic inguinal hernia repair yield excellent recurrence rates and no difference in postoperative complications or quality of life. Considering the lack of outcome difference with long-term follow-up, heavyweight mesh may be considered for use in laparoscopic inguinal hernia repair patients. Presented at the 2017 Annual Meeting of the American Hernia Society, where it received the Resident/Fellow Research Award.”

    DrBrown replied 5 years, 2 months ago 3 Members · 4 Replies
  • 4 Replies
  • DrBrown

    Member
    February 27, 2019 at 6:14 pm

    Dear Chaunce1234
    If you look at young males with indirect inguinal hernias, the recurrence rate is the same with a pure tissue repair when compared with mesh repair.
    Thus, especially in young males, there is no need for mesh.

    https://www.ncbi.nlm.nih.gov/pubmed/28391976

    Also if you do a literature search for postoperative pain after inguinal hernia repair, it is difficult to find any articles about the post op pain before the introduction of mesh. Which suggests that pain complications were minimal before the introduction of mesh.
    That is also my personal experience.

    Regards.
    Bill Brown MD

  • Chaunce1234

    Member
    February 26, 2019 at 11:31 pm

    There seems to be a significant number of different products with different outcomes, which surely confuses the tracking of outcomes and in determining what works best, when, why, for who, and, most importantly, what offers the best quality of life to the particular patient.

    The Swedish Hernia Register is an interesting source of information on hernia repairs and complications, and some fascinating studies are done using their data. Once such conclusion using a significantly larger sample size (13,000+ repairs) suggest that lightweight mesh is associated with less pain and less stiffness, but with slightly higher recurrence rate risk. Unfortunately the most important data that really matters to the patients – quality of life, chronic pain risk, pain severity, etc – is still not emphasized much at all, which is disappointingly typical.

    https://www.researchgate.net/publication/327210930_Lower_recurrence_rate_with_heavyweight_mesh_compared_to_lightweight_mesh_in_laparoscopic_totally_extra-peritoneal_TEP_repair_of_groin_hernia_a_nationwide_population-based_register_study

    Also, unrelated, but I stumbled into an older British study of 4000 patients that compared mesh and non-mesh repair, which found recurrence risk is 1.4% for mesh and 4.4% non-mesh – both sound quite low. But unfortunately there is no focus on chronic pain or quality of life of the patient in this study either, and there is no mention on the type of mesh used, nor the type of non-mesh repair used.

    https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2168.2000.01539.x

  • Good intentions

    Member
    February 26, 2019 at 8:49 pm

    Another video from the past, with some of the bigger names in the field, with a question about choosing from the huge assortment of meshes. 2011. The chaos and confusion is incredible.

    https://www.sages.org/video/discussion/

  • Good intentions

    Member
    February 26, 2019 at 7:33 pm

    From 2012 recommending lightweight mesh for chronic pain reduction.

    https://www.premiersurgical.com/06/study-recommends-lightweight-mesh-for-hernia-repair/

    Here’s Ethicon’s, using their own “International” hernia registry results to market light weight mesh.

    https://www.ethicon.com/na/products/hernia-mesh-and-fixation/hernia-mesh/ultrapro-partially-absorbable-lightweight-mesh

    • In the same study, patients reported improvement in pain and movement limitations from baseline at 1 year postsurgery2*

    * Data from a prospective, longitudinal study of 470 patients receiving laparoscopic, mostly inguinal, hernia repair with ULTRAPRO®Flat Mesh from the IHMR. Most complications reported: hematoma 1.3% and seroma 3.6%.

Log in to reply.