- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02712827
Comparison of Different Meshes in Laparoscopic Hernia Repair
A Randomized Controlled Trial Comparing Short Term Outcomes of Self-gripping (Progrip) Mesh With Fibrin Glue Mesh Fixation in Laparoscopic Total Extraperitoneal (TEP) Inguinal Hernia Repair
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Inguinal hernia repair is one of the common surgeries performed by general surgeon all over the world. Tension-free Lichtenstein repair is the most common technique used in open repair, while many surgeons perform laparoscopic hernia repair: total extraperitoneal repair (TEP) and transabdominal preperitoneal repair (TAPP). Laparoscopic surgery is considered to reduce postoperative pain, the incidence of wound complications and time to return to activities of daily living. Both techniques are based on the principle of tension free repair and rely on mesh placement in the preperitoneal space to exclude the inguinal defect and reinforce the abdominal wall; the recurrence rate following tension-free hernia repair is reported to be low and in the range of 1-4%.
Chronic pain after an inguinal hernia repair is a well recognized complication, irrespective of technique. The incidence of chronic pain is estimated to be around 5-10%. Many factors contributed to the development of chronic pain, and one of the factors being the type of mesh fixation method. Common types of mesh fixation methods in laparoscopic hernia repair are traumatic fixation - the use of tacks (absorbable or non-absorbable) or atraumatic fixation, e.g. the use of fibrin glue; while some surgeons do not fix the mesh. No fixation is practiced by some surgeons in unilateral repair as some studies showed that there was no difference in recurrence rate and incidence of chronic pain between fixation or no fixation groups, yet in these studies hernia opening was small (<3cm) or not measured. It is generally agreed that fixation is indicated in large hernias (defect size >3cm), bilateral hernias and recurrent hernias in order to avoid early mesh dislocation and hernia recurrence.
Study has shown that the use of tacks caused more early postoperative pain. Manufacturers try to develop self-gripping mesh with the aim to reduce chronic pain. ProgripTM (Covidien) is a lightweight, self-gripping mesh composed of monofilament polyester and polylactic acid (PLA) microgrips indicated for inguinal hernia repair. The resorbable microgrips provide immediate adherence to surrounding muscle and adipose tissue during hernia surgery, as a result no fixation method is required. Studies have shown that ProgripTM is associated with less pain in the early recovery period when used in open Lichtenstein repair, yet there are few studies of ProgripTM in laparoscopic hernia repair.
In Hong Kong, TEP is the preferred approach for most surgeons who perform laparoscopic hernia surgery. In this trial, patients with inguinal hernia who is suitable for TEP are recruited. TEP will be performed in the usual manner. Surgeon will assess the size of hernia defect prior to mesh insertion. For patients with large hernia defect or bilateral inguinal hernia that required mesh fixation, they will be randomized in two groups: ProgripTM and non-ProgripTM group. For ProgripTM no addition fixation is necessary, while for non-ProgripTM fixation is indicated. As tacks are known to be associated with postoperative pain, fibrin glue is designated as the fixation method in non- ProgripTM group in this study.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Hong Kong, Hong Kong
- Tung Wah Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age≥18
- Unilateral inguinal hernia with large hernia defect size (>3cm)
- Bilateral inguinal hernias
- American Society of Anesthesiologists (ASA) score: 1-2
- Provision of written informed consent
Exclusion Criteria:
- Any prior surgery for ipsilateral inguinal hernia (i.e. recurrent inguinal hernia)
- American Society of Anesthesiologists (ASA) score: 3 or above
- History of major abdominal surgery that may result in difficulty in development of preperitoneal space
- Subject is pregnant or breast feeding
- Any serious concomitant illness with short life expectancy
- Subject who is not able to attend follow up postoperatively
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Progrip
The Progrip group is the intervention group.
Patients will undergo laparoscopic total extraperitoneal repair of inguinal hernia.
The surgeon will use a self-gripping mesh to repair the hernia.
No fixation is required for the mesh.
|
Self-fixating mesh
|
Active Comparator: Non-Progrip
The Non-Progrip group is the control group. Operation is performed under general anesthesia. A standard three-trocar technique is used: one infra-umbilical camera trocar (1cm) and two 5mm trocars placed at midline between the umbilicus and pubic bone (or one at the side of inguinal hernia). A laparoscope is inserted to the preperitoneal space through the incision. The space is insufflated with carbon dioxide. Dissection is performed, hernia content (if any) is reduced. A non self-gripping synthetic mesh is placed. Fibrin glue is used for fixation. |
Non self-fixating mesh with the use of glue
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Chronic pain
Time Frame: 3 months post surgery
|
Chronic pain after hernia surgery was defined as the presence of pain at rest at the groin area.
The severity of pain will be measured by a linear analogue pain score sacle from 0 to 10. Score >= 1 indicate the presence of pain.
|
3 months post surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
mesh deployment time
Time Frame: 1 day
|
the time for mesh deployment during surgery
|
1 day
|
intraoperative complications
Time Frame: 1 day
|
intraoperative complications
|
1 day
|
hernia recurrence rate
Time Frame: 1 year
|
hernia recurrence rate
|
1 year
|
quality of life
Time Frame: 1 year
|
quality of life scores
|
1 year
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Dominic, Chi Chung Foo, MBBS, The University of Hong Kong
Publications and helpful links
General Publications
- Bresnahan E, Bates A, Wu A, Reiner M, Jacob B. The use of self-gripping (Progrip) mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair: a prospective feasibility and long-term outcomes study. Surg Endosc. 2015 Sep;29(9):2690-6. doi: 10.1007/s00464-014-3991-y. Epub 2014 Dec 18. Erratum In: Surg Endosc. 2015 Sep;29(9):2697.
- Kingsnorth A, Gingell-Littlejohn M, Nienhuijs S, Schule S, Appel P, Ziprin P, Eklund A, Miserez M, Smeds S. Randomized controlled multicenter international clinical trial of self-gripping Parietex ProGrip polyester mesh versus lightweight polypropylene mesh in open inguinal hernia repair: interim results at 3 months. Hernia. 2012 Jun;16(3):287-94. doi: 10.1007/s10029-012-0900-y. Epub 2012 Mar 28.
- Teng YJ, Pan SM, Liu YL, Yang KH, Zhang YC, Tian JH, Han JX. A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair. Surg Endosc. 2011 Sep;25(9):2849-58. doi: 10.1007/s00464-011-1668-3. Epub 2011 Apr 13.
- Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg. 2010 Dec;34(12):3065-74. doi: 10.1007/s00268-010-0760-5.
- Belyansky I, Tsirline VB, Klima DA, Walters AL, Lincourt AE, Heniford TB. Prospective, comparative study of postoperative quality of life in TEP, TAPP, and modified Lichtenstein repairs. Ann Surg. 2011 Nov;254(5):709-14; discussion 714-5. doi: 10.1097/SLA.0b013e3182359d07.
- Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009 Aug;13(4):343-403. doi: 10.1007/s10029-009-0529-7. Epub 2009 Jul 28.
- Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Fugger R, Scheyer M. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia. 2008 Aug;12(4):385-9. doi: 10.1007/s10029-008-0357-1. Epub 2008 Feb 19.
- Myers E, Browne KM, Kavanagh DO, Hurley M. Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg. 2010 Dec;34(12):3059-64. doi: 10.1007/s00268-010-0730-y.
- Langeveld HR, van't Riet M, Weidema WF, Stassen LP, Steyerberg EW, Lange J, Bonjer HJ, Jeekel J. Total extraperitoneal inguinal hernia repair compared with Lichtenstein (the LEVEL-Trial): a randomized controlled trial. Ann Surg. 2010 May;251(5):819-24. doi: 10.1097/SLA.0b013e3181d96c32.
- Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg. 2009 Jan;249(1):33-8. doi: 10.1097/SLA.0b013e31819255d0.
- Dulucq JL, Wintringer P, Mahajna A. Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years. Surg Endosc. 2009 Mar;23(3):482-6. doi: 10.1007/s00464-008-0118-3. Epub 2008 Sep 23.
- Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H. Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc. 2011 Jan;25(1):234-9. doi: 10.1007/s00464-010-1165-0. Epub 2010 Jun 15.
- Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am. 2003 Oct;83(5):1045-51, v-vi. doi: 10.1016/S0039-6109(03)00132-4.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- UW 16-042
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Hernia, Inguinal
-
Children's Mercy Hospital Kansas CityRecruitingInguinal Hernia | Inguinal Hernia, Indirect | Inguinal Hernia Unilateral | Inguinal Hernia BilateralUnited States
-
Hospital General Universitario ElcheCompletedInguinal Hernia | Inguinal Hernia Repair | Open Inguinal Hernia
-
San Bonifacio HospitalCompletedIndirect Inguinal Hernia | Direct Inguinal HerniaItaly
-
Bakirkoy Dr. Sadi Konuk Research and Training HospitalEnrolling by invitationInguinal Hernia | Strangulated Inguinal Hernia | Incarcerated Inguinal HerniaTurkey
-
University Hospital, GhentMedriCompleted
-
Ahmadullah DanishCompletedIncarcerated Inguinal HerniaAfghanistan
-
General Hospital of LarissaUnknown
-
Alexandria UniversityCompletedBilateral Inguinal Hernia
-
Hospital Siberia-SerenaUnknownPrimary Inguinal HerniaSpain
-
Diskapi Teaching and Research HospitalCompleted
Clinical Trials on Progrip
-
Karolinska InstitutetRecruitingIncisional Hernia of Midline of AbdomenSweden
-
The University of Hong KongQueen Mary Hospital, Hong Kong; Tung Wah HospitalCompleted
-
Helsinki University Central HospitalCompletedQuality of Life | Pain, Postoperative | Inguinal HerniaFinland
-
Medtronic - MITGCompleted
-
University Hospital, GhentMedtronic - MITGActive, not recruiting
-
Kuopio University HospitalHelsinki University Central Hospital; North Karelia Central Hospital; Paijat-Hame... and other collaboratorsUnknown
-
Helsinki University Central HospitalActive, not recruitingInguinal Hernia | SurgeryFinland
-
Helsinki University Central HospitalMedtronic - MITGCompletedInguinal Hernia | Primary | UnilateralFinland
-
Jacob RosenbergBispebjerg Hospital; University Hospital, Gentofte, Copenhagen; Frederikshavn... and other collaboratorsCompleted