epiglucan and Pain--Postoperative

Early post-operative pain after inguinal hernia repair delays management in ambulatory setting. The type of mesh used for repair appears to influence their incidence.. The aim of this randomized, prospective study using the alternation principle was to compare post-operative early pain and the quality of life of patients operated on for inguinal hernia depending on the type of mesh used and their impact on management in ambulatory setting.. Fifty successive patients were included prospectively. Hernia repair was performed using the Lichtenstein procedure with two types of mesh, namely standard polypropylene 100 g/m² (Prolène®) or light polypropylene (55 g/m²) with a natural beta-D-glucan coating (Glucamesh®). The main assessment criterion was post-operative pain evaluated twice daily by the patient for 7 days, using the visual analogue scale (VAS) and their use of analgesics. The secondary assessment criteria were the rate of unscheduled admissions the evening of the intervention and the hospital length of stay and the quality of life evaluated by the SF12 questionnaire at pre-operative stage and on days 7 and 30.. The two groups were comparable. The operative durations were identical (38.8±10.2 vs 48±15.4 min). On the evening of the intervention before discharge, the pain was less intense in the Glucamesh® group (mean VAS score 21.6±2.4 vs 31.7±6.2, p=0.02). On day 4, 20% of patients from the Glucamesh® group and none of the patients from the Prolène® group had a VAS score of 0 (p=0.02). There were no unscheduled admissions in either group, but the hospital stay was significantly shorter in the Glucamesh® group compared with the Prolène® group (288±35 vs 360±48 min, p=0.02). The post-operative quality of life evaluated by the SF12 questionnaire from day 7 to day 30 was the same in both groups (38±4.8 vs 37±5.2) and altered as at pre-operative stage compared with a control population (normal=50).. This randomized, prospective study showed that the use of a self-adhesive, light mesh, reducing the fixation sutures and coated with factors favouring tissue integration, such as the Glucamesh® prosthesis, significantly reduced early post-operative pain compared with conventional prostheses and could increase the percentage of patients likely to undergo an ambulatory hernia repair.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; beta-Glucans; Biocompatible Materials; Coated Materials, Biocompatible; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Polypropylenes; Prospective Studies; Prosthesis Implantation; Quality of Life; Surgical Mesh; Time Factors; Treatment Outcome; Young Adult

Prosthetic reinforcement is now routine in the management of inguinal hernia, and it significantly reduces the risk of recurrence. However, there may be postoperative pain and discomfort of late onset, the intensity of which appears to be related to the rigidity of the material and its ability to integrate with tissues. We have evaluated the results of implantation with beta glucan-coated polypropylene mesh both objectively (early recurrence) and functionally (pain and quality of life). The mass of the coated mesh is reduced by 50% compared to a typical polypropylene implant. Beta glucan is an entirely natural plant product that eliminates the risk of viral or prion contamination associated with the use of collagen of animal origin. One hundred fifteen patients with a mean age of 55 years with a primary or recurrent inguinal hernia were treated with a prosthesis (Glucamesh). Fifty-eight patients underwent a Lichtenstein procedure, and 57 had a laparoscopic procedure (TEP, TAPP). Mean operative time was 40 min. There was no mortality, and morbidity was 8.6%. At 3 months follow-up, no recurrences were observed. The characteristics of the prosthesis were considered to be good or excellent in 93.9-100% of cases. Residual postoperative pain (analogue pain score less than 2) occurred in 4.3% of cases at day 15 and in 2.7% at day 90. The quality-of-life health score of the SF36 questionnaire preoperatively and postoperatively showed a significant improvement ( P<0.05) in the scores and a quality of life equivalent to healthy control subjects. This prosthesis is associated with a rapid and significant resolution of postoperative pain and a quick return to normal activity with an improved quality of life. In addition, the plant origin of the prosthesis eliminates any risk of viral or prion contamination.

Topics: beta-Glucans; Coated Materials, Biocompatible; Glucans; Health Status Indicators; Hernia, Inguinal; Humans; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Prostheses and Implants; Quality of Life; Recurrence; Surgical Mesh