#Tinge unit for pain trial
#Tinge unit for pain series

Most recent studies have compared different types of mesh and different mesh placements. The key to TIPP mesh placement is adequate dissection of the preperitoneal space, which results in flat mesh placement covering the hernia defects. In our retrospective study, we noted that 1-layer preperitoneal mesh placement did not put patients at risk of future recurrence (< 1%). Some surgeons performing transinguinal preperitoneal (TIPP) mesh repair routinely place the optional onlay in the inguinal canal for fear of future recurrence.

Mesh manufacturers either make a single-unit, two-layer design (i.e., UHS and PHS mesh by Ethicon US, LLC) or a preperitoneal mesh with a separate optional onlay mesh to strengthen the posterior wall (i.e., PerFix Plug by Davol Inc. Careful nerve dissection and manipulation during inguinal canal preparation before mesh placement can help to reduce the chance of chronic pain, but mesh placed in the vicinity of inguinal canal nerves can cause inflammation, fibrosis and granuloma formation 7, 8, 9. Explanations for the high rate of chronic herniorrhaphy pain include periosteum damage during mesh positioning, nerve damage (due to stretching, division, compression, electrocautery injury) or inflammation from surrounding mesh materials 3, 4, 5, 6. Due to simplicity, Lichtenstein mesh repair is easy to learn, but post-herniorrhaphy chronic pain is a major drawback, with some studies reporting an incidence of up to 40% 3, 4. The invention of polypropylene mesh improved the recurrence rate but increased post-herniorrhaphy chronic pain (> 3 months). With decreased materials in the inguinal canal, single-layer TIPP has a lower rate of long-term postoperative discomfort without increasing the risk of future recurrence.īefore the introduction of polypropylene mesh, tissue repair was the main form of herniorrhaphy, but a poor long-term efficacy (> 10% recurrence in 10 years) and immediate postoperative pain were the main drawbacks 1, 2. Adequate dissection of the preperitoneal space is the key to a successful single-layer TIPP herniorrhaphy. No recurrence was noted in either group during the follow-up period. No patients experienced a foreign body sensation after 3 months in the 1-layer group, while five patients still had a foreign body sensation at 12 months in the 2-layer group.

Postoperative pain, numbness and soreness were similar between groups. Two patients in the 1-layer group and one patient in the 2-layer group were lost to follow-up. The average follow-up period was 29 months. The patient demographics were similar between the two groups. The primary endpoints included foreign body sensation, pain, and any other discomfort in the inguinal region following surgery and the secondary endpoints included recurrence and any complications related to surgery.

#Tinge unit for pain series

A blinded researcher performed post-operative interviews using a series of questions at 1, 3, 6, and 12 months after surgery, and another unblinded researcher organized and performed statistical analysis of the peri-operative and post-operative data. A single surgeon performed the same operation to place the preperitoneal mesh in both groups, the only difference being the placement of the optional onlay mesh in the study group. The control group received a single-layer modified Kugel mesh in the preperitoneal space, while the study group received the optional onlay mesh in the inguinal canal with preperitoneal mesh placement.

#Tinge unit for pain trial

This prospective, single-surgeon, single-center, randomized trial compared two groups of 50 consecutive patients at a 1 to 1 ratio. This study evaluated any counterproductive effects of adding the onlay to single-layer TIPP mesh herniorrhaphy and compared the long-term efficacy. For peace of mind, most surgeons still incorporate the optional onlay.

Mesh manufacturers make either a single-unit, two-layer mesh design or a separate optional onlay with the pre-peritoneal mesh.

Transinguinal preperitoneal (TIPP) single-layer mesh herniorrhaphy has been proven effective.