Hernia : the journal of hernias and abdominal wall surgery
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Randomized Controlled Trial Comparative Study
Comparison of polypropylene versus polyester mesh in the Lichtenstein hernia repair with respect to chronic pain and discomfort.
Inguinal hernias are the most common operative procedure performed by general surgeons, and tension-free mesh techniques have revolutionized the procedure. While hernia recurrence rates have decreased, chronic postoperative pain has become recognized more widely. New mesh products offer the potential to decrease pain without compromising recurrence rates. Polyester mesh is a softer material than traditional polypropylene and may offer the benefit of causing less postoperative pain and improved quality of life. ⋯ Polyester mesh does not decrease the amount of chronic pain at 3 months. Outcomes with polyester mesh are comparable to polypropylene mesh for Lichtenstein inguinal hernia repair with regards to postoperative pain and quality of life. The sample size in this study was small and limits the significance of the results. Further studies are needed to find the optimal mesh for inguinal hernia repair.
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Randomized Controlled Trial
Comparison of three concentrations of simplex lidocaine in local anesthesia for inguinal hernia mesh-repairs.
The aim of the present randomized clinical study was to assess the efficacy of simplex lidocaine in local anesthesia for inguinal hernia mesh-repairs, compare analgesia of three different concentrations of lidocaine, and explore use of lower concentrations of lidocaine in local anesthesia for inguinal hernia mesh-repairs. ⋯ The local anesthesia technique was good with lidocaine alone in local anesthesia for inguinal hernia mesh-repairs. A concentration of 3.3 mg/mL lidocaine provided similar analgesia as 5 or 8 mg/mL lidocaine.
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Randomized Controlled Trial Comparative Study
One-year results of a prospective, randomised clinical trial comparing four meshes in laparoscopic inguinal hernia repair (TAPP).
A low rate of chronic pain and maximum postoperative comfort are the main goals today in inguinal hernia repair. This four-arm randomised trial compares these parameters after laparoscopic hernia repair (TAPP) with a standard heavyweight mesh (HW), a pure middleweight polypropylene mesh (MW), a lightweight composite polypropylene mesh (LW), or a titanised lightweight mesh (TLW). The primary endpoint of the study was the incidence of chronic pain of any severity at the site of hernia repair at 1 year. ⋯ Compared to HW mesh, the use of MW, LW, and TLW meshes for laparoscopic hernia repair did not significantly affect rate of chronic pain, but seemed to improve early postoperative convalescence. No difference was found between middleweight pure polypropylene (MW), composite lightweight (LW), or titanised lightweight polypropylene (TLW) meshes.
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Randomized Controlled Trial Multicenter Study
The design of an industry-sponsored randomized controlled trial to compare synthetic mesh versus biologic mesh for inguinal hernia repair.
Biologic prostheses are designed to support tissue regeneration rather than just result in a strong scar plate, as is the case with synthetic mesh. It is not known if these newer materials will result in earlier return to normal activities and/or less post-herniorrhaphy groin pain. METHOD/STUDY DESIGN: A prospective, randomized, controlled, third-party-blinded multicenter trial was designed to compare the use of a non-cross linked porcine dermis biologic graft [Strattice(TM) Reconstructive Tissue Matrix (RTM), LifeCell, Branchburg, NJ] versus light weight, large pore polypropylene mesh (UltraPro(TM), Ethicon, Somerville, NJ). The study design called for recruitment of 170 men. These men are being followed for a minimum of 2 years. The primary aim of this study is to compare the safety and effectiveness of the two materials in a Lichtenstein inguinal hernia repair as measured by resumption of activities of daily living. Secondary outcomes include chronic pain, postoperative complications and the incidence of re-herniation at 12 and 24 months. ⋯ We report the design of a multi-center, third-party blinded, randomized clinical trial comparing a new surgical device with existing technology in the repair of inguinal hernias. We believe this investigator-designed and conducted trial could serve as a model for similar trials examining surgical devices performed in collaboration with industry.
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Randomized Controlled Trial Comparative Study
Preemptive analgesia with midazolam and diclofenac for hernia repair pain.