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. 2024 Apr;28(2):401-410.
doi: 10.1007/s10029-023-02748-5. Epub 2023 Feb 8.

Prediction of successful revision surgery for mesh-related complaints after inguinal hernia and pelvic organ prolapse repair

K L C Van Rest  1   2 , M J C A M Gielen  3 , L M Warmerdam  4 , C R Kowalik  5   6   4   7 , J P W R Roovers  5   6   4   7 , W A R Zwaans  3   7   8   9
Affiliations

Prediction of successful revision surgery for mesh-related complaints after inguinal hernia and pelvic organ prolapse repair

K L C Van Rest et al. Hernia. 2024 Apr.

Abstract

Purpose: With this retrospective case series, we aim to identify predictors for reduction of pain after mesh revision surgery in patients operated for inguinal hernia or pelvic organ prolapse with a polypropylene implant. Identifying these predictors may aid surgeons to counsel patients and select appropriate candidates for mesh revision surgery.

Methods: Clinical records before and after mesh revision surgery from 221 patients with chronic postoperative inguinal pain (CPIP) and 59 patients with pain after pelvic organ prolapse (POP) surgery were collected at two experienced tertiary referral centers. Primary outcome was patient reported improvement of pain after revision surgery. A multivariable logistic regression model was used to specify predictors for pain reduction.

Results: The multivariable logistic regression was performed for each patient group separately. Patients with CPIP had higher chances of improvement of pain when time between mesh placement and mesh revision surgery was longer, with an OR of 1.19 per year. A turning point in chances of risks and benefits was demonstrated at 70 months, with improved outcomes for patients with revision surgery ≥ 70 months (OR 2.86). For POP patients, no statistically significant predictors for reduction of pain after (partial) removal surgery could be identified.

Conclusion: A longer duration of at least 70 months between implantation of inguinal mesh and revision surgery seems to give a higher chance on improvement of pain. Caregivers should not avoid surgery based on a longer duration of symptoms when an association between symptoms and the location of the mesh is found.

Keywords: Foreign bodies / complications; Foreign bodies / surgery inguinal hernia; Pain, Postoperative; Pelvic organ prolapse; Polypropylene; Surgical mesh.

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Conflict of interest statement

J.P.W.R. Roovers is an expert consultant for Coloplast Nederland, The Netherlands, and Promedon, Argentina. Other authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Improvement of symptoms displayed by time between mesh placement and removal
Fig. 2
Fig. 2
Risk–benefit profile, distribution of complications over time within participants with and without improvement of symptoms after revision surgery
See this image and copyright information in PMC

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