Hernia (2008) 12:39–43 DOI 10.1007/s10029-007-0275-7 123 ORIGINAL ARTICLE Comparison of recurrence with lightweight composite polypropylene mesh and heavyweight mesh in laparoscopic totally extraperitoneal inguinal hernia repair: an audit of 1,232 repairs D. Akolekar · S. Kumar · L. R. Khan · A. C. de Beaux · S. J. Nixon Received: 9 February 2007 / Accepted: 19 July 2007 / Published online: 13 September 2007  Springer-Verlag 2007 Abstract Background In Edinburgh a group of surgeons agreed to convert to a lightweight, composite mesh (Ultrapro—Ethi- con) for totally extraperitoneal (TEP) inguinal hernia sur- gery. The aim of this study was to compare the outcome following the use of a new lightweight vs a standard heavy- weight mesh during TEP hernia repair. Methods Patients undergoing TEP using lightweight (LWM) or heavyweight meshes (HWM) between March 2004 and March 2006 were identiWed from the Lothian Sur- gical Audit database. The patients who re-presented with recurrence of hernia were studied in greater detail. Date of re-attendance at a clinic with recurrence was used as a sur- rogate for date of recurrence. Results Two hundred and Wfty one patients had 371 her- nia repairs with LWM. A total of 16 (4.3%) recurred with a median follow-up of 14.5 months. A concurrent group of 326 patients had 425 repairs with standard mesh and have had 12 (2.82%) recurrences with a median follow-up of 22.4 months. A group of patients operated immediately prior to the introduction of LWM consisted of 328 patients who had 436 repairs using HWM, of whom 13 (2.98%) have recurred with a median follow-up of 43 months. Whilst there are no statistically signiWcant diVerences in recurrence rates between these groups, we are concerned that the LWM group has the highest recurrence rate despite the shortest follow-up. Conclusion In view of increased patient comfort, we con- tinue to recommend LWM for laparoscopic inguinal hernia surgery but would recommend that, in larger hernias and possibly for all, the surgeon should improve mesh adhe- sion. Keywords Inguinal · Hernia · Recurrence · Mesh · Lightweight Introduction There is growing interest in the use of lighter weight meshes (LWM) for all types of hernia repair based upon predicted beneWts when compared with heavyweight mesh (HWM). These include accelerated recovery with less post- operative pain [1] and earlier return to normal activity [2], increased patient comfort with reduced mesh awareness [3] and less chronic pain [4–6] with improved quality of life [3, 7, 8]. Claims are also made for a decreased tendency to shrink due to reduced intensity of collagenisation with a possible reduction in late recurrence and increased resis- tance to infection [9]. Use of lightweight mesh to avoid par- astomal hernia in the presence of severe peritoneal contamination has been reported [10]. However, surgeons may be wary of using a material of reduced strength with a perceived risk of increased recurrence but may be reassured by the knowledge that even the lightest of meshes available are still three times stronger than a human abdominal wall. However, this concern can only be heightened by early reports suggesting that increased recurrence has occurred with LWM although suggesting this may be due to techni- cal errors in Wxation [6, 11]. A group of surgeons in Edinburgh were suYciently impressed by the predicted beneWts of lightweight mesh to agree to change to the use of lightweight, composite, poly- propylene, monocryl-coated mesh (Ultrapro—Ethicon) for D. Akolekar · S. Kumar · L. R. Khan · A. C. de Beaux · S. J. Nixon (&) Department of Surgery, Royal InWrmary Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, UK e-mail: Stephen.nixon@ed.ac.uk