Introduction: Chronic postoperative inguinal pain (CPIP) remains one of the most important long-term complications after laparoscopic groin hernia repair, despite lower rates than with open surgery. Whether different mesh types and fixation methods influence the risk of persistent pain remains uncertain, and comparative real-world evidence has been limited.
Introduction:
Chronic postoperative inguinal pain (CPIP) remains one of the most important long-term complications after laparoscopic groin hernia repair, despite lower rates than with open surgery. Whether different mesh types and fixation methods influence the risk of persistent pain remains uncertain, and comparative real-world evidence has been limited.
Why was this study needed?:
. CPIP significantly affects long-term quality of life after inguinal hernia repair.
. The optimal combination of mesh type and fixation technique remains controversial.
. Large comparative studies evaluating commonly used mesh–fixation combinations are lacking.
. Identifying the safest and most cost-effective strategy could improve surgical outcomes.
Results:
This nationwide Swedish registry study evaluated over 15,000 patients undergoing unilateral laparoscopic groin hernia repair, with more than 10,500 providing 1-year patient-reported outcomes. Among 12 commonly used mesh–fixation combinations, three strategies were associated with the lowest risk of chronic postoperative inguinal pain: heavyweight flat mesh without fixation, lightweight flat mesh fixed with fibrin glue, and lightweight self-gripping mesh with micro-hooks. Heavyweight flat mesh without fixation performed as well as the other low-pain strategies while avoiding fixation devices altogether, making it the simplest and least expensive approach.
Clinical Impact:
These findings support selecting mesh–fixation strategies that minimize chronic pain without compromising repair quality. Heavyweight flat mesh without fixation appears to be a practical default option, combining low chronic pain risk with lower procedural complexity and cost. The results also reinforce previous registry evidence demonstrating acceptable recurrence rates with non-fixation techniques.
Bottom Line:
Heavyweight flat mesh without fixation was associated with one of the lowest risks of chronic postoperative inguinal pain after laparoscopic groin hernia repair, supporting it as a simple, effective, and cost-efficient default strategy.
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