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Comparison of polypropylene versus polyester mesh in lichtenstein inguinal hernia repair with respect to chronic pain
Ajay P1, Sampathkumar Poral2, Sindujaa Sn3
1Department of General Surgery, Jawaharlal institute of post graduate medical education and research(JIPMER), Dhanvantri nagar, Puducherry, 605006, India. srimugilmecse@gmail.com.
Purpose:
Chronic postoperative groin pain remains a clinically significant complication following Lichtenstein inguinal hernia repair. Prosthetic mesh characteristics may influence both inflammatory response and postoperative outcomes. This study aimed to compare polypropylene and polyester mesh with respect to chronic pain, postoperative complications, and inflammatory changes.
Methods:
This prospective, single-center, single-blind randomized controlled trial was conducted between December 2019 and February 2021. Fifty patients with primary unilateral uncomplicated inguinal hernia were randomized in a 1:1 ratio to receive polyester mesh (n = 25) or polypropylene mesh (n = 25). Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 1 week and 3 months, and chronic pain was evaluated using the Inguinal Pain Questionnaire (IPQ). Surgical site complications were recorded at 1 week and 3 months. Serum Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (HS-CRP) levels were measured preoperatively and at 12 h postoperatively.
Results:
Baseline characteristics were comparable between groups. At 1 week, mean VAS scores were 1.72 ± 1.43 in the polyester group and 1.84 ± 1.49 in the polypropylene group (p = 0.76). At 3 months, mean VAS scores were 0.76 ± 0.66 and 0.92 ± 0.57, respectively, with no statistically significant difference. IPQ parameters demonstrated comparable chronic pain and functional outcomes. Early postoperative swelling was significantly more frequent in the polypropylene group (p = 0.001), while other surgical site complications were similar between groups. Postoperative IL-6 and HS-CRP levels were significantly higher in the polypropylene group at 12 h (p < 0.05). No recurrence was observed in either group.
Conclusion:
Polypropylene and polyester meshes demonstrated comparable short-term pain, chronic pain, and recurrence outcomes following Lichtenstein inguinal hernia repair. Polyester mesh was associated with lower early postoperative inflammatory markers and reduced early swelling, although these differences did not translate into significant differences in 3-month pain outcomes. Larger multicentric studies with longer follow-up are required to clarify the long-term clinical significance of these findings.
