Risk Factors for Chronic Pain Following Laparoscopic Groin Hernia Repair in the Swedish Hernia Registry: 2. Mesh and Fixation Combinations

Abstract Background A recent Swedish Hernia Registry (SHR) study associated standard, aka “heavyweight”, polypropylene flat mesh (StdPPM) without fixation, and lightweight polypropylene or polyester based flat mesh (LWM) with fibrin glue, with the lowest reoperation risks (Novik, et al. J Am Coll Surg 2022). Aim The present prospective cohort study aimed at correlating mesh/fixation combinations with chronic postoperative inguinal pain (CPIP) risk. Material and Methods Virtually all patients ≥15 years, operated with TEP or TAPP in Sweden during September 2012—December 2018, were routinely sent a CPIP questionnaire at 1 year postoperatively. This study defined CPIP widely, as “non-ignorable pain in the operated groin anytime during the recent week”. A. Mesh alternatives: StdPPM LWM Anatomically (“3D”) shaped polypropylene mesh, standard or lightweight. Non-characterized polyester mesh. B. Fixation alternatives: Non-fixation Tacks Fibrin glue Progrip® self-gripping absorbable micro-hooks (only with LWM). Thirteen mesh/fixation combinations were analyzed with multivariable logistic regression, rendering adjusted odds ratios with 95% confidence intervals. Effect modifiers adjusted for were sex, age, ASA, body mass index, smoking, recurrent hernia, emergency repair, bilateral vs. unilateral, and anatomical type and defect size of hernia. Results Eighty surgical centers contributed 29,109 laparoscopic repairs (78% male). Patient mean age was 58 years. From 20,455 (70%) questionnaire responders, 5,786 (28%) qualified as having CPIP. With non-fixated StdPPM as reference, some mesh/fixation combinations were associated with a significantly higher CPIP risk, while no alternative combinations correlated with a lower risk. Conclusions Of the mesh/fixation combinations associated with the lowest CPIP rates, non-fixated StdPPM is the least expensive, and can therefore be recommended.