Table 55. Key Question 5: Treatment details
Study / Treatment A / Treatment B / Treatment C / Treatment D / Comments /Gundre et al., 2011703 / Tension-free repair with 15 cm x 7.5 cm polyethylene mesh / Tension-free repair with 15 cm x 7.5 cm polypropylene mesh / NA / NA / Same antibiotic (ciprofloxacin) and analgesic (diclofenac sodium) were gaven to all patients. Authors subjected polyethylene mesh to different tests to study composition and properties.
Sadowski et al., 2011797 / Lichtenstein with polyester mesh / Lichtenstein with polypropylene mesh / NA / NA / All subjects were given a prescription for 30 tablets of hydrocodone/APAP 5/500. Those with an allergy or intolerance of hydrocodone/APAP were given a similar prescription for propoxyphene/APAP. One patient received polypropylene mesh instead of polyester which was their original randomized allocation. This patient was included in the polyester mesh group for intention to treat analysis and in the polypropylene mesh group for per protocol analysis.
Bittner et al., 2011636,637 / TAPP with Prolene mesh, 10 x 15 cm, polypropylene monofilamental mesh of 90 g/m2, pore size 1.2mm (Ethicon) / TAPP with Premilene mesh, 10 x 15 cm, pure polypropylene 55 g/m2, pore size 0.75 mm. (Aesculap) / TAPP with Ultrapro mesh, 10 x 15 cm, composite mesh 28 g/m2, pore size 3-4 mm (Ethicon) / TAPP with TiMesh, 10 x 15 cm, 35 g/m2, pore size >1 mm, monofilamental polypropylene mesh coated with titanium (GfE). / All meshes were fixed with a 1 mL fibrin glue (1 mL sealer protein solution and 1 mL thrombin solution Tissucol, Baxter). All operations done under general anesthestia (sevoflurane/desflurane in combination with a 70:30% mixture of nitrous oxide and oxygen). All patients received thromboembolic prophylaxis with a low molecular weight heparin and a one-shot antibiotic prohylaxis immediately before surgery. More than 10,000 repairs had been carried out since that time before starting this trial.
Agarwal et al., 2009623 / TEP with heavyweight polypropylene mesh (PPM) / TEP with lightweight mesh (LWM) reduced polypropylene large pore / NA / NA / Surgeon experienced in TEP; a15 x 12cm size mesh (PPM on one side and LWM on the other side) positioned to cover the myopectineal orfice.
Ansaloni et al., 2009627,628 / Lichtenstein with PP 6x14 cm that was slit part way 1 cm from its inferior edge to accommodate the spermatic cord (Angimesh 9, PRE6x14), sutured with Prolene 3/0 / Lichtenstein with SIHM, an acellular collagenic matrix obtained from pig small intestine; 8 x 13 cm and fixed with polydioxanone 2/0 / NA / NA / The surgeon was highly specialized, performing more than 500 hernia repairs a year and with over 30 years of experience in general surgery; For all direct hernias, independent of size, the nerniation was inverted behind a narrowing stay suture of 2/0 polypropylene. The meshw as tailored to cover the area from the inguinal ligament to the lateral border of the rectus sheet, and from the superior pubic ramus to 6 cm lateral to the internal orfice of the inguinal canal. The corners were curved and 1 cm of the mesh was doubled and incorporated into the suture along the inguinal ligament, in order to reinforce the suture line and prevent rupture of the mesh.
Bringman et al., 2003642-644 / Lichtenstein with 7.5x15cm Prolene (Ethicon) / Lichtenstein with 7.5x15cm VYPRO II (Ethicon) / NA / NA / General anesthesia for 69%(204/295) in the Prolene group and 58%(172/296) in the Vypro group. Local anesthesia for 11% (32/295) in the Prolene group and 12% (35/296) in the Vypro group
Bringman et al., 2005645 / TEP with Prolene 12x15cm / TEP with Vypro II 12x15cm / NA / NA / All meshes fixed with staples. There were two fixed operation teams with profound experience in TAPP (more than 200).
Champault et al., 200788 / Lichtenstein with polypropylene of weight per unit area 105 g/m2 (Bard,Ethicaon) / Lichtenstein with Glucamesh (Genzyme) apolypropylene with a weight per unit of 50g/m2 coated with beta-d-glucan / Laparoscopic repair with polypropylene of weight per unit area 105 g/m2 (Bard, Ethicaon) / Laparoscopic repair with Glucamesh (Genzyme) apolypropylene with a weight per unit of 50g/m2 coated with beta-d-glucan / All operations were performed by the same team of two certified general surgeons; Meshes fixed with nylon sutures underneath the external fascia (inlay technique)
Chauhan et al., 2007658 / Group 1: indigenous device - from standard prolene sheet two patches are designed. Dimensions are tailored to the individual patient’s anatomy and held together by a single loose Prolene suture in the middle. / Group 2: conventional Prolene Hernia System (PHS) (Ethicon) / NA / NA
Chowbey et al., 2010660 / Endoscopic TEP with Prolene: polypropylene mesh (Ethicon), heavyweight, made up of multifilaments of polypropylene (nonabsorbable) fibers. 105 g/m2, 0.8to1 mm pore size, 0.685mm mesh thickness, 1,630mmHg maximum tensile strength / Endoscopic TEP with Ultrapro: composed of a weave of lightweight polypropylene (nonabsorbable) fibers and poliglecaparone (absorbable) fibers. Poliglecaparone which is a monofilament, gives mesh added stiffness for handling, particularly during mesh placement in endoscopic inguinal hernia repair. Absorbed in approx. 90 days, 28 g/m2, approx 3 to 4 mm pore size, 0.5 mm mesh thickness, 650 mmHg maximum tensile strength. / NA / NA / All meshes used were 5x10cm2. All surgical procedures were performed by the same senior surgeon (GD). Allhernias were classified as type II and IIIa according to Nyhus. Lichtenstein technique using a prosthesis that was positioned and fixed to the inguina ligament with a continuous nonabsorbable suture (2/0Prolene, Ethicon)
Chui et al., 2010661 / TEP with lightweight mesh: Dynamesh (FEG Textiltchnik); rectangular mesh was tailor-made with a tongue-like flap fashioned with scissors forming the posterior fold to accommodate the spermatic pedicle, and inserted without need for further fixation; patients received 1G of cefazolin intravenously at start of operation (prophylactic antibiotic) / TEP with heavyweight mesh: Surgipro (Tyco Healthcare); rectangular mesh was tailor-made with a tongue-like flap fashioned with scissors forming the posterior fold to accommodate the spermatic pedicle, and inserted without need for further fixation; patients received 1G of cefazolin intravenously at start of operation (prophylactic antibiotic) / NA / NA / All procedures were performed by or under the supervision of a single consultant surgeon with comprehensive 15year experience in a board variety of advanced laparo-endoscopic procedures.
DeBord et al., 1999668 / Open or Laparoscopic with Standard patch: polytetrafluoroethylene (ePTFE) / Open or Laparoscopic with Impregnanted Patch: expanded polytertafluoroethylene (ePTFE) soft-tissue patches impregnante with antimicrobial preservative agents (GORE-TEX® Dual-Mesh® Plus Biomaterial and GORE-TEX® MycroMesh® PLUS Biomaterial - W.L.Gore & Associates) / NA / NA / The decision to use a prosthetic device and to use a dual-surface (DualMesh Biomaterial) or uniform-surface (MycroMesh Biomaterial) ePTFE patch was made by the attending surgeon; however, the dual-surface material was used in all laparscopic procedures. Both standard and impregnated patches were available in the operating room. Each surgeon in the study implanted a total of three standard patches and three impregnated patches in random orde. When dual-surface ePTFE patches were used for a ventral hernia repair, the textured surface of the prosthesis was placed adjacent to the fascia and the smooth surface toward bowel.
Di Vita et al., 2010670 / Lichtenstein with Prolene: high density, doublemonofilament of PP, poresize 1 mm, thickness = 0.40 mm, total density= 108 g m(2), Ethicon. / Lichtenstein with Vypro II: partially absorbable mesh consisting of nonabsorbable PP and absorbable PG, pore size 2-3 mm, thickness of 0.4mm, and density 83 g m(2), Ethicon / NA / NA / TEP performed by the same surgeon with expertise in this technique. Meshes were only fixed in selected cases (large direct hernia) with a spiral tacker (Protrack, Covidien) on the Cooper ligament. In the case of bilateral hernia, identical meshes were used on both sides.
Freudenberg et al., 2006696 / Lichtenstein with Nylon Mesh: nylon mesh was bought as knotted mosquito net at local market; trimmed to a standard size of 10x15cm, cleaned with alcohol and water; packed into cotton gauze; and sterilized in the autoclave of hospital. Manufacturer confirmed that it was 100% nylon (polyamide 6/6). The mosquito net was not impregnante with pyrethrum or other insecticides. It’s weight is 27 g/m2, it’s thickness 0.22 mm, and maximal diameter of pores is 2.5mm / Lichtenstein with Ultrapro mesh (Ethicon Products): 10 x 15 cm, a composition of aborbable polyglactin fibers and nonabsorbable polypropylene fibers. Itsweight is 28 g/m2, itsthickness 0.5 mm, maximal diameter of pores is 3.5 mm / NA / NA / Lichtenstein was performed as described by Amid et al using 2-0 polypropylene (Prolene) to secure mesh. Five surgeons, experienced in the lichtenstein technique participated in study.
Heikkinen et al., 2006709 / TEP with 12 x 15 cm piece of PROLENE (Ethicon) / TEP with a 12 x 15 cm piece of VYPRO II (Ethicon) / NA / NA / Local anesthesia to the wounds in all patients except one in the Prolene group
Kapischke et al., 2010716 / Lichtenstein with Parietene progrip® (Covidien, germany): 11x9 cm mesh fixed by short steady pressure exerted by the surgeon / Lichtenstein with Optilene® (braun, Germany): polypropylene (PP) mesh, 12x 10 cm. Suture material was 2/0 polypropylene (Surgipro, Covidien, Germany) / NA / NA / X
Khan et al., 2010717 / Lichtenstein with lightweight mesh composite (Vypro II®) / Lichtenstein with heavyweight mesh propylene (Prolene®) mesh / NA / NA / fixed interiorly at the medial end with continous 2/0 polypropylene suture. Three or four interrupted sutures were use dto fix the mesh superiorly.
Koch et al., 2008724 / Lichtenstein descriebd by Amid with 10 x 15cm titanium coated polypropylene lightweight mesh of 35 g/m2 in weight (TiMesh TC) / Lichtensteing described by Amid with 10 x 15 cm standard polypropylene mesh weighing more than 80 g/m2 (Prolene) / NA / NA / Mesh was fixated with separate stitches of polypropylen (Prolene3/0, Ethicon product)
Langenbach et al., 2003733 / TAPP with monofile, heavyweight (108 g/m2) rigid polypropylene; synthetic, colorless mesh (Ethicon) with thickness of 0.9mm / TAPP with smooth heavy weighted variant (116g/m2) or polypropylene mesh composed of mutifile material; synthetic, colorless mesh (Serag-Wiessner) with thickness of 0.5 mm / NA / NA / The participation surgeons were all experienced in laparoscopic hernia repair. Meshes were fixed using spiral tacks (Protract, Tycohealthcare)
Langenbach et al., 2006734 / TAPP with polypropylene (Ethicon): monofilament, 4.6 pores/cm, 108g/m2, 1.0-1.6 mm pore size, 0.9mm thickness, traction lengthwise (N) 597, traction crosswise (N) 767 / TAPP with smooth polypropylene (Serag-Wiessne): multifilament, 6pores/cm, 116 g/m2, 0.08-1.0 mm pore size, 0.5 mm thickness, traction lengthwise (N) 595, traction crosswise (N)77 / TAPP with Compound mesh (Ethicon): polypropylene/polyglactin, multifilament, 2 pores/cm, PP 26.8 g/m2/ PG54.6g/m2, 2.05.0mm pore size, 0.9mmthickness, traction lengthwise (N) 387, traction crosswise (N) 63 / NA / In patients with bilateral hernias, a different type of mesh was placed on each side by randomization. The patients were operated on by the same senior consultant with good experience of inguiunal hernia surgery. Allmeshes were 9 x 13 cm
Langenbach et al., 2008735 / TAPP with Prolene: adouble-filament heavyweight (108 g/m2) polypropylene mesh / TAPP with Serapen: multifilament heavyweight variant (116 g/m2) of polypropylene mesh / TAPP with Vypro II: composite multifilament mesh made of polyglactin (PG) and polypropylene (PP) (PP 35 g/m2) / NA / Laparoscopic repair (totally extraperitoneal approach or TEP) was preferred for bilatera hernias or for hernias that recurred after herniorrhaphy in young (20-45years) active professionals or sportsmen or women with not anesthetic risk, with a BMI under 30. All other patients underwent lichtenstein repair
Nikkolo et al., 2010773 / Lichtenstein with heavyweight (HW) mesh: monofilament polypropylene mesh with a pore size of 0.8mm and a weight of 82 g/m2 (Premilene® Mesh, Braun). / Lichtenstein with lightweight (LW) mesh: monofilament polypropylene mesh with a pore size of 1.0mm and a weight of 36 g/m2 (Optilene® Mesh LP; braun). / NA / NA / In both groups, a mesh of dimensions 4.5 x 10 cm was applied and polypropylene 2/0 suture material was used for mesh implantation.
O’Dwyer et al., 2005775 / Lichtenstein with lightweight mesh: constructed of multifilaments of polypropylene with additional absorbable polyglactin (Vypro II, Ethicon); pore size of 4mm, weighs 82 g/m2 at implantation and 32g/m2 after absorption of polyglactin compoenet (approx 56-70 days) / Lichtenstein with heavyweight mesh (Atrium, Atrium Medical): pore size 1 mm, weighs85 g/m2 / NA / NA
Paajanen, 2007781 / Lichtenstein with Vypro II: partly absorbable polypropylene-polyglctin mesh 50g/m2 / Lichtenstein with Premilene Mesh LP: lightweight polypropylene mesh 55 g/m2 / Lichtenstein with Premilene: conventional densely woven polypropylene mesh 82g/m2 / NA / All meshes were the same size 15 x 10cm; the two surgeons who carried out the operative procedure had a training status of more than 300 laparoscopic hernia repairs.
Paradowski et al., 2009784 / Lichtenstein with Surgimesh (WN, Aspide Medical): a reinforcement patch not knitted, notwoven, made from polypropylene consolidated by heat sealing, low weight 43g/m2 / Lichtenstein with Micromesh (W.L. Gore & Associates): polytetrafluoroethylene (PTFE) mesh / Licthenstein with Surgipro(Auto Suture): standard woven polypropylene (PP) mesh, heavyweight 80 g/m2 / NA