Chronic groin pain after Lichtenstein inguinal hernia repair: partially absorbable light-weight mesh versus conventional light-weight versus heavy-weight mesh.

INTRODUCTION

Mesh properties are important contributing factors to chronic postoperative inguinal pain (CPIP) following Lichtenstein inguinal hernia repair. Some studies show using a light-weight mesh (LWM, <50 g/m2) over heavy-weight mesh (HWM, >70 g/m2) may decrease CPIP. However, most studies do not distinguish between partially absorbable light-weight mesh (PA-LWM) and permanent LWM. This study compares the rates of CPIP between PA-LWM, LWM, and HWM after Lichtenstein inguinal hernia repair.

METHODS

A retrospective analysis of the ACHQC database from 2014 to 2024 was conducted for elective Lichtenstein repair of non-recurrent, unilateral inguinal hernias. Mesh was categorized as LWM <50 g/m2 or HWM ≥70 g/m2 distinguishing partially absorbable LWM. The primary outcome was the rate of CPIP at 6 months postoperatively for PA-LWM, LWM, and HWM.

RESULTS

319 patients met criteria for the study with 53 PA-LWM, 122 LWM, and 144 HWM patients. Baseline pain was highest in PA-LWM and lowest in HWM cohorts. At 6 months, 21% of PA-LWM, 21% of LWM, and 19% of HWM patients had chronic pain (p=0.93). This decreased to 3% for PA-LWM at 1-year, but remained approximately 20% for LWM and HWM (p = 0.045). The clinical recurrence rate at 1-year was 50% (2/4), 0% (0/8), and 0% (0/17) for PA-LWM, LWM, and HWM respectively (p = 0.001).

CONCLUSION

This study found that roughly 20% of patients have chronic pain at 6 months regardless of mesh weight or partially absorbable properties. While PA-LWM may decrease CPIP at 1 year, this may be accompanied with a higher clinical recurrence rate.