Comparison of Two Polypropylene Meshes With Different Areal Densities in Open Lichtenstein Repair of Primary Inguinal Hernia: A Prospective, Quasi-Randomized Controlled Trial

Background and objective: Chronic and early postoperative pain remain important concerns after open inguinal hernia repair, and mesh characteristics may influence these outcomes.This trial compared ultralightweight (<35 g/m²) with lightweight (35-70 g/m²) polypropylene mesh in Lichtenstein repair, focusing on postoperative pain and hernia recurrence, to determine whether a further reduction in mesh density improves pain outcomes without compromising efficacy in working-age men.Methods: In this single-center, parallel-group controlled trial with alternate (quasi-random) allocation, 80 men aged 18-60 years with primary inguinal hernia were allocated 1:1 to ultralightweight (<35 g/m²) or lightweight (35-70 g/m²) polypropylene mesh (n=40 per group) during Lichtenstein hernioplasty.Postoperative pain was assessed on a visual analog scale (VAS) at postoperative day (POD) 1, one week, six weeks, six months, and one year.Recurrence, operative time, hospital stay, early complications, and chronic pain (>3 months) were also recorded.Results: Baseline demographics (age, body mass index, hernia side, Nyhus type) were comparable between groups.Operative time was similar (47.90 ± 7.99 vs 48.15 ± 8.25 min; p=0.891), and hospital stay trended shorter with ultralightweight mesh (3.07 ± 0.27 vs 3.23 ± 0.42 days; p=0.061).VAS pain scores were significantly lower with ultralightweight mesh at POD 1 (2.90 ± 0.81 vs 4.72 ± 1.18; mean difference -1.82, 95% CI -2.27 to -1.38; p<0.001) and at one and six weeks (p<0.001),but converged by six months and one year.Early complications were comparable (seroma 7.5% vs 10%; hematoma 5% vs 7.5%).Chronic pain occurred less often with ultralightweight mesh, though the difference was not statistically significant (0% vs 7.5%; p=0.239).No recurrence was observed in either group.Conclusions: Ultralightweight mesh reduced early postoperative pain compared with lightweight mesh in Lichtenstein hernioplasty, with a comparable early complication profile.No recurrence was observed in either group during one year of follow-up; however, the trial was not powered to detect differences in recurrence.Ultralightweight mesh was associated with lower early postoperative pain scores in working-age men, but longer, adequately powered studies are needed to assess recurrence and durability.