Updates in Surgery

, Volume 70, Issue 1, pp 77–83 | Cite as

Pain and quality of life after inguinal hernia surgery: a multicenter randomized controlled trial comparing lightweight vs heavyweight mesh (Supermesh Study)

  • Stefano Bona
  • Riccardo Rosati
  • Enrico Opocher
  • Barbara Fiore
  • Marco Montorsi
  • On behalf of the SUPERMESH Study Group
Original Article


Mesh repair has significantly reduced recurrence rate after groin hernia surgery. Recently, attention has shifted to issues such as chronic pain and discomfort, leading to development of lightweight and partially re-absorbable meshes. The aim of the study was to evaluate the effect of lightweight mesh vs heavyweight mesh on post-operative pain, discomfort and quality of life in short and medium term after inguinal hernia surgery. Eight hundred and eight patients with primary inguinal hernia were allocated to anterior repair (Lichtenstein technique) using a lightweight mesh (Ultrapro®) or a heavyweight mesh (Prolene®). Primary outcomes were incidence of chronic pain and discomfort at 6-month follow-up. Secondary endpoints were quality of life (QoL), pain and complication at 1 week, 1 and 6 months. At 6 months, 25% of patients reported pain of some intensity; severe pain was reported by 1% of patients in both groups. A statistically significant difference in favour of lightweight mesh was found at multivariable analysis for pain (1 week and 6 months after surgery: p = 0.02 and p = 0.04, respectively) and QoL at 1 month and 6 months (p = 0.05 and p = 0.02, respectively). There was no difference in complication rate and no hernia recurrences were detected. The use of lightweight mesh in anterior Lichtenstein inguinal hernia repair significantly reduced the incidence of pain and favourably affected the perceived quality of life at 6 months after surgery compared to heavyweight mesh.


Inguinal hernia surgery Lichtenstein repair Lightweight mesh 



SUPERMESH Study Group: Bechi P, Firenze; Bona S, Milano; Carlucci M, Milano; Colizza S, Roma; Danelli PG, Milano; .D’Ambra L, La Spezia; Di Sebastiano P, San Giovanni Rotondo (FG); Fiore B, Milano; Fiscon V, Cittadella (PD); Lo Bello R, Napoli; Logrieco G, Acquaviva delle Fonti (BA); Montorsi M, Milano; Morpurgo E,Camposanpiero (PD); Opocher E, Milano; Perrone G, Bergamo; Rosati R, Milano; Sansonetti G, Cinisello Balsamo (MI); Schillaci V, Catania; Sgroi G, Treviglio (BG).

Compliance with ethical standards

Conflict of interest

S.B. declares potential conflict of interest (he was a paid consultant for Johnson & Johnson Medical until 2013). No other author reports potential conflict of interest.

Research involving human participants and/or animals

This study has been approved by the appropriate institutional research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Written informed consent was obtained by all patients upon enrolment.


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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  1. 1.UO di Chirurgia Generale e DigestivaHumanitas Research Hospital and UniversityRozzano (Milan)Italy
  2. 2.UO di Chirurgia GastroenterologicaOspedale San RaffaeleMilanItaly
  3. 3.UO Chirurgia II Epato-Bilio-Pancreatica e DigestivaAzienda Ospedaliera San PaoloMilanItaly

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