Clinical Outcomes and Quality of Life Following Different Mesh and Fixation Methods in Inguinal Hernia Repair: A Retrospective Registry-Based Study

TL;DR

This study compares anatomical and flat meshes in hernia surgery, finding that anatomical meshes improve early recovery but not long-term outcomes.

Contribution

Quantifies the short-term clinical benefits of anatomical mesh over flat mesh in standardized fixation hernia repair.

Findings

Anatomical mesh showed better pain, sensation, and movement scores at one month.

No significant differences were observed between mesh types at six months.

Anatomical mesh provides transient early recovery benefits but does not affect long-term quality of life.

Abstract

Background: The choice of mesh in totally extraperitoneal (TEP) inguinal hernia repair remains a subject of debate, particularly regarding the optimal mesh shape. While anatomical and flat meshes are widely used, few studies have rigorously compared the impact of mesh shape while standardizing other surgical factors like fixation. Consequently, there is limited evidence to quantify the clinical and economic value of potential early recovery benefits. We aimed to determine if anatomical mesh shape provides superior early patient-reported outcomes compared to flat mesh when a standardized metallic fixation technique is used in both groups.

Methods: This retrospective cohort study included 80 patients undergoing elective TEP inguinal hernia repair. Patients were categorized to receive either a three-dimensional anatomical mesh (n=39) or a standard flat mesh (n=41), with both groups undergoing standardized metallic tack fixation. The primary outcomes were patient-reported outcome measures (PROMs) assessed at one and six months postoperatively. Instruments included the validated Thai version of the Carolinas Comfort Scale (TCCS) for hernia-specific symptoms and the EQ-5D-5L with a Thai value set for health-related quality of life (HRQoL).

Results: At the one-month follow-up, the anatomical mesh group demonstrated significantly better outcomes, with lower mean scores across all TCCS domains - Pain (7.77 ± 0.97 vs. 10.14 ± 0.96), Mesh Sensation (7.02 ± 0.92 vs. 9.17 ± 1.14), and Movement (6.95 ± 0.89 vs. 8.91 ± 1.08) - and a higher EQ-5D-5L utility score (0.819 ± 0.019 vs. 0.784 ± 0.016; p < 0.001 for all). By six months, there were no statistically significant differences between the groups in either TCCS domains or EQ-5D-5L scores.

Conclusions: When the fixation method is standardized, the anatomical shape of the mesh is associated with a significantly better quality of life and fewer symptoms during the first month of recovery, a benefit that is transient. This study quantifies the value of early postoperative recovery, providing crucial evidence for a trade-off analysis between the higher cost of anatomical mesh and its tangible, short-term clinical benefits. These findings are essential for facilitating informed, value-based decisions in surgical practice.