Page 64 - herina surgery and possible lawsuits

• Neumayer m very well-conducted, large multicentre randomized controlled study
found a chrome pain incidence of 10% after laparoscopy and 14% after open surgery
(P>0.05), and recurrence rate of 10% and 4.9% respectively at 2 years. [135]
Chronic pain in relation to mesh / non-mesh repairs:

• A comparative analysis between non-mesh (Bassini's) and mesh (Lichtenstein) repair
of primary inguinal hernia postoperative pain were significantly low (p < 0.001) in

Lichtenstein meshplasty.[136]
• EU Hernia Trialists in his review found less pain after mesh repair compared to non­
mesh repair [133] Similar observations were reported by Poobalan et al [16].

• In contrast Bay-Nielsen found no difference in young males operated with mesh or
non-mesh repair. [116]

• The Cochrane Database Systematic Review is the highest level of evidence. In 2002
Cochrane retrospective study five randomized controlled trials, 1,51,3008 patients,
not depend on the operative technique and concluded that the implantation of meshes
significantly decreases the overall recurrence rate, the occurrence of chronic pain and

the time of return to normal activity, as compared to non-mesh techniques. [77]
Chronic pain in relation to Types of Mesh:
There are many meshes available for hemioplasty mcludes heavy prolene mesh, soft prolene

mesh, Vypro mesh, Ultrapro mesh etc. These had showed different pain incidences.
• Bringman observed that chrome pain, stiff abdomen, and foreign body sensation are
least often observed with the use of a lightweight mesh [84].

• Komnger found that the patients with titanium coated lightweight mesh had a shorter
convalescence than those with the standard heavyweight mesh but there was no
difference in postoperative pam or recurrence at the 1-year follow-up. [99]

• Leardi concluded that even suture less plug mesh had 13.0% rate of early post
operative pain which was 25% after 2-4 years follow up, but pam is mild in nature
and not seriously affect the patients quality of life. [137] In contrast, Millikan et al had

0.4% chronic pain with longer follow up in senes of more than 2000 patients.[138]
• Smietanski in prospective cohort study on lightweight poliglecaprone/polypropylene
mesh (UltaPro) concluded that use of partially absorbable light mesh reduces

postoperative pain at long-term follow-up.[139]

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