Abstract
Background
The use of lightweight mesh for inguinal hernia repair has been suggested to be preferable
compared with heavyweight mesh. Nevertheless, surgeons do not use lightweight mesh
routinely, possibly owing to the higher price and lack of confidence in evaluation
of previous evidence. The aim of this systematic review and meta-analysis is to update
the available randomized controlled trials and provide a recommendation on the use
of lightweight mesh or heavyweight mesh in open inguinal hernia repair.
Methods
A literature search was conducted in May 2019 in MEDLINE, Embase and the Cochrane
library for randomized controlled trials comparing lightweight (≤50 g/m2) and heavyweight (>70 g/m2) mesh in patients undergoing open (Lichtenstein) surgery for uncomplicated inguinal
hernias. Outcomes were recurrences (overall, after direct or indirect repair), chronic
pain (analyzing any and severe pain), and the feeling of a foreign body. The level
of evidence was assessed using GRADE. Risk ratios and 95% confidence intervals were
calculated by random effect meta-analyses.
Results
Twenty-one randomized controlled trials involving 4,576 patients (lightweight mesh
2,257 vs heavyweight mesh 2,319) were included. Follow-up ranged from 3 to 60 months.
No difference between lightweight mesh and heavyweight mesh was determined for recurrence
rates (lightweight mesh 42 of 2,068 and heavyweight mesh 34 of 2,132; risk ratios
1.22; 95% confidence interval, 0.76–1.96) or severe pain (lightweight mesh 14 of 1,517
and heavyweight mesh 26 of 1,591; risk ratios 0.73; 95% confidence interval, 0.38–1.41).
A significant reduction was seen for any pain after lightweight mesh (234 of 1,603)
compared with heavyweight mesh (322 of 1,683; risk ratios 0.78; 95% confidence interval,
0.64–0.96) and for the feeling of a foreign body (lightweight mesh 130 of 1,053 and
heavyweight mesh 209 of 1,035; risk ratios 0.64; 95% confidence interval, 0.51–0.80).
Conclusion
Lightweight mesh should be used in open (Lichtenstein) inguinal hernia repair.
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Article info
Publication history
Published online: October 28, 2019
Accepted:
August 20,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
