Impact of different meshes on patient reported outcomes and complications following TEP repair: a comparative approach


  • Sanam Jindal Department of General and Laproscopic Surgery, Sri Gangaram Hospital, New Delhi, India
  • Arun Kakkar Department of General and Laproscopic Surgery, Paras Hospital, Gurugram, Haryana, India
  • Yogesh Jhamb Department of General and Laproscopic Surgery, Max Super specialty Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
  • Jasdeep Singh Lamba Department of General and Laproscopic Surgery, Yashoda Hospital, Kaushambi, New Delhi, India



Hernia, Heavy weight mesh, Light weight mesh, Total extraperitoneal repair


Background: Minimally invasive inguinal hernia surgery originated in the early 1990s and is gaining popularity in the field of general surgery. A mesh provides a tension-free repair with strengthening of the abdominal wall. This study was undertaken to compare traditional polypropylene and lightweight meshes in TEP inguinal hernioplasty in terms of post-operative patient reported outcomes.

Methods: A total of 65 patients were enrolled in the study. Patients were divided into 3 groups i.e. Polypropylene (21), TiMesh-16 (24) and Ultrapro (20) based on mesh used. Assessment of pain was done using visual analogue scale (VAS). Patient reported outcomes were observed on 1st post-operative day (POD), 7th day, 1 month, 6 months and 1 year. Data was analysed using SPSS software ver.22.

Results: A total of 94 hernias were operated in 65 patients. Mean operative time in both unilateral and bilateral cases was not significant and showed no correlation with type of mesh used. Mean VAS score of prolene group was significantly more than Ultrapro and TiMesh groups on POD1, POD7, 1 month and 6 months, showing p=0.027 (POD1), p=0.002 (POD7), p=0.017 (1 month) and p=0.00 (6 months) respectively. Patients in LWM groups showed earlier return to activities than Prolene group. No recurrence was observed in either group on 1 year follow-up. Among the study patients, complications of TEP observed were accidental rupture of peritoneum, scrotal swelling, seroma, sub-cutaneous emphysema and conversion to lichtenstein mesh hernioplasty.

Conclusions: As per the observations, Light weight mesh placement in TEP Hernioplasty results in better patient reported outcomes.


Ammar S, Ismail T. Abdominal wall hernias in upper Egypt: a different spectrum. East Central African J Surg. 2008;13(2):109-13.

Lee HK, Park SJ, Yi BH. Multi-detector CT reveals diverse variety of abdominal hernias. Diagnostic Imaging. 2010;32(5):27-31.

Kulacoglu H. Current options in inguinal hernia repair in adult patients. Hippokratia. 2011;15(3):223-31.

Brown CN, Finch JG. Which mesh for hernia repair? Ann R Coll Surg Engl. 2010;92(4):272-8.

Schouten N, van Dalen T, Smakman N, Elias SG, Clevers GJ, Verleisdonk EJMM, et al. The effect of ultrapro or prolene mesh on postoperative pain and well-being following endoscopic Totally Extraperitoneal (TEP) hernia repair (TULP): study protocol for a randomized controlled trial. Trials. 2012;13:76-82.

Agarwal BB, Agarwal KA, Sahu T, Mahajan KC. Traditional polypropylene and lightweight meshes in totally extraperitoneal inguinal herniorrhaphy. Int J Surg. 2010;8(1):44-47.

Mishra RK. Complications of Laparoscopic Surgery. Curr Medical J India. 2004;10(3):1036-9.

Chowbey PK, Pithawala M, Khullar R, Sharma A, Soni V, Baijal M. Complications in groin hernia surgery and the way out. JMAS. 2006;2(3):174-7.

Agarwal BB, Agarwal KA, Mahajan KC. Prospective double-blind randomized controlled study comparing heavy- and lightweight polypropylene mesh in totally extraperitoneal repair of inguinal hernia:early results. Surg Endosc 2009;23(2):242-7.

Prakash P, Bansal VK, Misra MC, Babu D, Sagar R, Krishna A, et al. A prospective randomised controlled trial comparing chronic groin pain and quality of life in lightweight versus heavyweight polypropylene mesh in laparoscopic inguinal hernia repair. J Minimal Access Surg. 2016;12(2):154-61.

Shah BC, Goede MR, Bayer R, Buettner SL, Putney SJ, McBride CL, et al. Does type of mesh used have an impact on outcomes in laparoscopic inguinal hernia? Am J Surg. 2009;198(6):759-64.

Uzzaman MM, Ratnasingham K, Ashraf N. Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. Hernia. 2012;16(5):505-18.

Lomanto D, Katara AN. Managing intra-operative complications during totally extraperitoneal repair of inguinal hernia. J Min Access Surg. 2006;2(3):165-70.

Hasbahceci M, Basak F, Acar A, Alimoglu O. A new proposal for learning curve of TEP inguinal hernia repair:Ability to complete operation endoscopically as a first phase of learning curve. Minimally Invasive Surg. 2014;2014:1-5.

Choi YY, Kim Z, Hur KY. Swelling after laparoscopic total extraperitoneal repair of inguinal hernias: review of one surgeon’s experience in 1,065 cases. World J Surg. 2011;35(1):43-6.

Saggar VR, Singhal A, Singh K, Sharma B, Sarangi R. Factors influencing development of subcutaneous carbon dioxide emphysema in laparoscopic totally extraperitoneal inguinal hernia repair. J Laproendosc Adv Surg Tech A. 2008;18(2):213-6.

Ates M, Dirican A, Ozgor D, Gonultas F, Isik B. Conversion to stoppa procedure in totally extraperitoneal inguinal hernia repair. JSLS. 2012;16(2):250-4.






Original Research Articles