Mesh-fixation combinations and chronic postoperative inguinal pain after laparoscopic groin hernia repair: nationwide cohort study.

BACKGROUND

Despite lower prevalence after laparoscopic approach, chronic postoperative inguinal pain (CPIP) remains a major concern. Large-scale comparisons of various mesh-fixation combinations with respect to CPIP risk are scarce. This study evaluated the association between commonly used mesh-fixation combinations and CPIP after laparoscopic groin hernia repair.

METHODS

This comparative cohort study analysed prospectively collected data from the nationwide Swedish Hernia Registry, including virtually all adult patients undergoing unilateral laparoscopic groin hernia repair in Sweden over a 6-year 4-month period. One year after surgery, a patient-reported outcomes survey assessed CPIP, defined as pain in the operated groin during the preceding week that affected daily activities. This study also classified all patients who underwent reoperation within the first 15 months as CPIP-positive respondents. Multivariable logistic regression estimated adjusted odds ratios for mesh-fixation combinations recorded in > 100 procedures.

RESULTS

Of 15 360 eligible patients, 10 525 (68.5%) responded (mean age 59 years; 32.0% women). Three mesh types (flat heavyweight, flat lightweight, and 'three-dimensional') and five fixation modes (absorbable tacks, metal tacks, fibrin glue, self-gripping micro-hooks, and non-fixation) yielded 12 analyzable combinations. The lowest odds of CPIP were observed with three options: heavyweight flat mesh without fixation (reference category; adjusted odds ratio 1.0), lightweight mesh with fibrin glue (adjusted odds ratio 1.0, 95% confidence interval 0.75 to 1.4), and lightweight mesh with self-gripping micro-hooks (adjusted odds ratio 0.94, 95% confidence interval 0.61 to 1.4).

CONCLUSION

Heavyweight flat mesh without fixation was associated with one of the lowest odds of CPIP, while representing the simplest and least costly alternative. Together with previous registry evidence indicating low recurrence risk, these findings support considering this option as a pragmatic default strategy in laparoscopic groin hernia repair.