Our experience in using self-gripping mesh during Liechtenstein repair. Randomized control trail

Mekhaeel Mekhaeel Shehata Fakhry, Salem Sameh Mohamed Ahmed^*, Protasov Andrey Vitalevitch

Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical institute. Department operative surgery and clinical anatomy named after I.D. Kirpatovsky. Moscow, Russian Federation.

^*Corresponding Author: Salem Sameh Mohamed Ahmed, Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Medical institute. Department operative surgery and clinical anatomy named after I.D. Kirpatovsky. Moscow, Russian Federation.

Received: 17 November 2024; Accepted: 26 November 2024; Published: 27 December 2024

Introduction

The adhesiveness of self-gripping meshes (SGM) [1] is related to being double-sided [2]; first with small hooks made from multifilament-polyethylene-terephthalate (PET) [3] with monofilament-polypropylene (PP) [4], second with small allowing grips’ attachment [5]. Moreover, AdhesixTM mesh is coated by polyethylene-glycol (PEG) and polyvinylpyrrolidone (PVP) [6], ProgripTM possess micro-grips made of polylactic-acid (PLA) [7].

SGM during open anterior hernioplasty Liechtenstein [8] have avoided the drawbacks of sutured fixation [9]. Modifications upon SGM [10] included methods of spreading [11]; The four-fold and rolling techniques [12], Swiss-roll folding [13] mesh deployment technique [14], reduced operative-time and post-operative pain [15].

Materials and Methods

50 patients were included in our comparative clinical trial whom were divided into two equal groups; A & B (no=25). Non-pregnant patients aged between 21-71 years old with unilateral non-complicated primary inguinal hernia had fulfilled our inclusion criteria. Our comparative criteria included; operative-time, duration of hospital stays (beds/day) toghter with the incidence of complications during the postoperative period and during short-term follow-up for six months. We operated both groups using Liechtenstein tension-free open anterior hernioplasty.

For group (A) patients; we applied Adhesix™ SGM (Figure1) and for group (B) patients; we applied Progrip™ SGM (Figure 2). The distribution of sexes, average age and hernial side are illustrated in (Table 1).

Figure 1: Adhesix™ SGM. Source [16]

Figure 2: Progrip™ SGM. Source [17].

Table 1: The count of patients, average of age and the sex of patients in each group.

Results

1) Operative time

The analysis showed significant differences regarding the duration of the operation; using Adhesix™ SGM have reduced operative-time by almost 5 minutes incomparison to ProgripTM SGM (Average operative time was 25.7 minutes for group (A) versus 30.6 minutes for group (B). (Figure 3).

Figure 3: Mann- Whitney test for independent sample. Vertical axis; time of the operation (minutes), horizonal axis; mesh types (1; AdhesixTM ,2; ProgripTM). Data are presented as mean values ± standard deviation, * - p=0.016, statistically significant differences relative to time of operation. Source [7]

For the Adhesix™ SGM group -average = 25.68, median = 27.0, Sd = 1.078.

For the Progrip ™ SGM group -average operation time = 30.6, median = 30, Sd = 1.615.

Report: 30.6±1.615vs 25.68±1.078 min; U=190.5, p=0.016). (Table 2).

Table 2: Ground total operative-time in both groups.

2) Hospital stays (beds/day)

We found no significant differences regarding the duration of hospitalization among both groups (p=0.759).

Mean hospital stays for Adhesix™ self-gripping mesh implants group - mean = 4.72, median = 5.0, Sd = 0.339.

Mean hospital stays for the Progrip™ self-gripping mesh implants group – mean = 4.56, median = 4.0, Sd = 0.259.

Report: 4.56±0.259 vs 4.72±0.339 days; U=328, p=0.759). (Table 3). (Figure 4).

Table 3: Number of hospitals stays for both patients’ groups.

Figure 4: Mann-Whitney test for independent sample. Vertical axis; duration of hospital-stays (days); horizonal axis; mesh type (1; AdhesixTM ,2; ProgripTM). Data are presented as mean values ± standard deviation, * - p=0.7596 statistically no significant differences relative to duration of hospital-stays. Source [7].

3) Complication in the postoperative period

In group (A); The number of patients who had postoperative pain, which was relieved by analgesics, while in all other patients of this group, the pain gradually decreased when taking NSAIDs (OR = 1.000; CI 0.130 - 7.717; p=1.00) and other members of this group had surgical site infection. (OR = 0.92; CI 0.820 -1.033; p=0.149) are mentioned in § table 4. In group (B); The number of patients who had postoperative pain, which was relieved by analgesics, while in all other patients of this group the pain was gradually reduced when taking NSAIDs (OR = 1.000; CI 0.130 - 7.717; p=1.00) and other members of this group had surgical site infection. (OR = 1.087; CI 0.968 - 1.220; p=0.149) are also mentioned (Table 4).

4) Complications during the short-term follow-up for six months

For group (A); All patients were satisfactory without any complications or recurrences (OR = 0.92; CI 0.820 -1.033; p=0.149), the number of patients with chronic pain in the surgical area, foreign body sensation and seromas are mentioned. (Table 5).

For group (B), we also found all patients were satisfactory without any complications or recurrences (OR = 1.087; CI 0.968 -1.220; p=0.149), the number of patients with chronic pain in the surgical area, foreign body sensation and seromas are mentioned (Table 5).

Table 4: Number of postoperative complications in both groups.

Table 5: Incidence of complications in 6-months follow up for both groups.

Discussion

Regarding our study questions; Is the are any significant differences between Adhesix^TM SGM and Progrip^TM SGM regarding operative-time??? duration of hospital stays??? the incidences of complications and hernia recurrences during the post-operative period and the shot-term follow-up??? We obtained the following answers:

1.The duration of the operation using the Adhesix™ SGM was significantly reduced incomparison to the use of Progrip^TM SGM.

2.There are no significant differences regarding the duration of hospitalization among both groups.

3.The use of both SGMs; Adhesix™ & Progrip™ did not increase the risk of postoperative pain and is not associated with an increased risk of surgical site infection.

4.The use of both SGMs; Adhesix™ and Progrip™ did not show any complications (chronic pain, foreign body sensation, seroma formation) or recurrences during short-term follow-up for six months.

Controversies raised by this study; Is there is a correlation between Progrip^TM SGM and increased incidence of surgical site infection incomparison to the use of Adhesix^TM SGM??? Which may need further future studies to interpretate this query. In another words; Does the micro-grips involved the structure of Progrip^TM SGM responsible for such drawback??? For further investigations.

Author contribution

Concept and design: MMSF, SSMA, PAV; Review of literature: MMSA, SSMA; Drafting the article and figure preparation: MMSA, SSMA; Revising and editing the manuscript: MMSF. Final approval of the article: MMSA, SSMA, PAV.

Funding

All the authors declare that they didn’t receive any grants or fundus from any organization. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.

Competing interests

All the authors have read the manuscript and declare no conflict of interest. No writing assistance was utilized in the production of this manuscript.

Consent for publication

All the authors have read the manuscript and consented for publication.

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16. https://biopsy-medical.ru/upload/iblock/605/6056e4fc6a9606a95804c62d65ce6ff6.jpg
17. https://www.researchgate.net/publication/329767549/figure/fig1/AS:705361937965058@1545182799611/ The-micro-hooks-distributed-over-all-the-internal-surface_W640.jpg