Outcomes of porcine small intestinal submucosa mesh compared to polypropylene mesh in laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective cohort study.

objectiveTo compare the long-term outcomes of porcine small intestinal submucosa (SIS) mesh and polypropylene (PP) mesh after an laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.

backgroundMesh-based surgical techniques for inguinal hernia repair are recommended in the guidelines due to the lower rate of recurrence. Biologic meshes (BMs) may have advantages in terms of chronic pain due to the different postoperative remodeling, without the disadvantages of a permanent implant. SIS mesh is the most commonly used BMs, mostly used for young male patients. Until now, the long-term efficacy of SIS mesh in laparoscopic inguinal hernia repair (LIHR) has rarely been reported and remains elusive.

methodsWe retrospectively reviewed prospectively collected data from consecutive LIHR performed at Beijing Chaoyang Hospital between January 1, 2014 and December 31, 2018. Two groups of meshes were selected: SIS mesh and PP mesh. To reduce potential selection bias, patients were matched based on the logit of propensity scores through age, gender, and body mass index (BMI). Follow-up was until January 30, 2024. Long-term outcomes were analyzed, including the rate of recurrence, the rate of re-operation, and the postoperative discomfort.

resultsA total of 2,348 patients with LIHR were eligible. After exclusion criteria, a total of 1,240 unilateral hernias treated using the TAPP approach were included for statistical analysis. Of these, 143 hernias (11.5%) were operated on with SIS mesh. Applying propensity score matching resulted in 115 matched pairs for comparative analysis. The mean operative time with the SIS mesh was 63.2 ± 18.5 min, which was longer than the operative time with PP mesh of 50.1 ± 17.6 min (P < 0.001). The SIS mesh was used more frequently to repair indirect hernias, while the PP mesh was more often employed to direct and femoral hernias at a higher rate (P = 0.009). The mean follow-up was 84.2 months and a total of seven patients (3%) were lost to follow-up. Overall, five (2.3%) patients experienced hernia recurrence postoperatively, all in the SIS group, but no statistical difference was observed between the two groups (4.4% vs. 0%; P = 0.06). All underwent a second operation, with three in TAPP approach and two in Lichtenstein approach, no recurrence was found afterward. More patients in the SIS group reported postoperative discomfort than those in the PP group (8.8% vs. 0.9%; P = 0.006), notably experiencing discomfort more frequently and to a greater degree during movement.

conclusionThe SIS mesh in TAPP hernia repair leads to more frequent discomfort and a higher recurrence rate (though not statistically significant) compared to PP mesh. Continued follow-up and an increased sample size are needed to analyze the effectiveness of SIS mesh and to explore risk factors for recurrence.