JSM Surgical Procedures

Prospective Multicenter Blinded Randomized Study Comparing PP and PVDF Mesh Implants in Lichtenstein Procedure with Respect to Pain and Recurrence

Research Article | Open Access Volume 1 | Issue 1 |
Article DOI :

  • 1. La Fe University Hospital, Spain
  • 2. Hospital Nuestra Senora del Rosario, Spain
  • 3. Complejo Hospitalario de Toledo, Spain
  • 4. La Mancha-Centro General Hospital, Spain
  • 5. Hospital Municipal de Badalona, Spain
  • 6. Hospital Juan Ramon Jimenez, Spain
  • 7. Henares University Hospital, Francisco de Vitoria University, Spain
  • 8. Hospital Reina Sofia, Spain
  • 9. University Hospital, Santiago de Compostela, Spain
  • 10. University Hospital del Mar, Spain
  • 11. Valld’HebrónUniversity Hospital, Spain
  • 12. Fundacion Alcorcon University Hospital, Spain
  • 13. Hospital de Torrejón de Ardoz, Spain
  • 14. Hospital Santa Cristina, Spain
+ Show More - Show Less
Corresponding Authors
Providencia García-Pastor, Abdominal Wall Surgery Unit, La Fe University Hospital, Valencia, c/ Planells, 54-2. 46460 Silla, Valencia, Spain, Tel: 34639860197.

Polyvinylidene fluoride (PVDF); Polypropylene (PP)


Inguinal hernia repair is one of the most performed surgical treatments with over 20 million patients annually worldwide [1]. For men and women the lifetime risk of inguinal hernia which needs treatment is estimated to be 27% and 3%, respectively[2]. Although surgical treatment is successful in the majority of cases recurrences which require reoperation still occur in 10-15% of cases. Beside recurrence, long-term disability due to pain is a problem and occurs in 10-12% of cases [1]. Thus, both recurrence and pain are still major complications in inguinal hernia surgery. There are several risk factors linked to chronic pain such as the intraoperative nerve management, the use of different fixation methods, the mesh material or its pore size although this is an ongoing debate in literature [3-5]. Today, the Lichtenstein technique, which was introduced in 1986 and named after its inventor, is the standard open tension-free method for inguinal hernia repair and often referred to as the “gold standard”[6]. In order to minimize chronic pain after inguinal hernia repair, one of the key factors is to identify the “best” mesh composed of the “best” biomaterial. Both Polypropylen (PP) and Polyvinylidene fluoride (PVDF) are well-established and widely used polymer for medical devices. However, PVDF seems to provide some crucial benefits as its high biocompatibility, long-term stability and the unnecessity of additional additives might increase its clinical impact in the future [1,7-13].


The objective of this study was to compare the performance of a PVDF- and a PP-mesh in terms of pain, chronic pain, comfort (numbness and foreign body sensation) and postoperative complications after primary bilateral inguinal hernia repair during a follow-up of one year


Study design and setting

The study is a prospective multicenter blinded randomized trial. Overall 19 Spanish centers participated in the study. The majority of cases (65%) were included by five centers. Patients were operated either as out-patient without hospitalization or inpatient. All operations were performed by surgeons experienced in abdominal wall surgery (only consultants, no residents).

Participants - Inclusion criteria

Only male patients with primary bilateral inguinal hernia (Aachener classification LI-III, MI-III, McI-III[14]), aged between 17 and 90 were included in the study. All patients were asked to sign the written informed consent prior to the intervention and only those who agreed were included into the study.

Participants - Exclusion criteria

Our exclusion criteria were defined as: ASA score IV and higher, emergency surgery, recurrent hernia, scrotal hernia, coagulation disorders, neurological disorders, psychologically instable and refusal to sign informed consent.

Outcome parameters

Pain and chronic pain were defined as primary outcome parameters. Additional patient reported outcome parameters were foreign body sensation and numbness. As secondary outcome parameters the early (≤ 7 days post-operatively: seroma, hematoma, infection, early recurrence) and late (> 7 days ≤ 1 year post-operatively: recurrence, mesh migration) postoperative complications were recorded.

Surgical technique

All patients were operated either under general, spinal or local anesthesia with the Lichtenstein technique standardized according to Amid described in [6]. Amid emphasized the importance of standardization of the procedure however at the same time he endorsed technical considerations whenever necessary. These technical considerations include nerve and/or hernia sac resection. All patients were treated with a Polypropylen (PP) mesh on one side and a Polyvinyliden fluoride (PVDF) mesh on the other side. As PP meshSurgipro® by Covidien/Medtronic, Mansfield, USA was used. Surgipro is a flat mesh made from PP monofilaments (Ø ~ 140 µm) with a textile porosity of 49%. As PVDF mesh DynaMesh®- LICHTENSTEIN by FEG TextiltechnikmbH, Aachen, Germany was used. DynaMesh-LICHTENSTEIN is a flat but pre-slit mesh made from PVDF monofilaments (Ø ~ 130 µm) with a textile porosity of 73%. Patients were not aware of which side the PP or PVDF mesh was placed. The blinded study design ensured that the assessment of the patient reported outcome (PRO) parameters was independent of the mesh type. For the fixation of the mesh to the inguinal ligament Prolene 00 (Ethicon, Johnson and Johnson Company, Cincinnati, OH, USA) was used and the oblique muscle - tendon assembly was perfomed using Vicryl 00 (Ethicon, Johnson and Johnson Company, Cincinnati, OH, USA).


Patients were invited to an outpatient clinical follow up at the 7th day, 3 months, 6 months and 12 months postoperatively. The clinical follow up was not necessarily done by the same surgeon who performed the intervention. Patients were asked about their pain perception using the visual analogue scale (VAS). Patients with a VAS score > 4 at the 3-months follow-up or later were considered as chronic pain patients. In addition the patients were asked to assess the PRO parameters “foreign body sensation” and “numbness”, which were defined as dichotomous variables.

Study design limitations

(1) A limitation of the study design is the single blinded design. In a double blinded design the surgeon performing the clinical follow-up would not have been aware of the mesh type used on each side. (2) Further limitation of the study design might be the capturing of PRO data by simple dichotomous categorical variables or VAS scales instead of comprehensive standardized questionnaires as CPPS (chronic pain prevention screener), SPS (surgical pain scale), IPQ (inguinal pain scale) or EQ-5D. With each of these standardized questionnaires we would have substantially extended the case report form (CRF). Considering the situation of a financially underpowered study we faced the dilemma of having either a comprehensive CRF and just a low number of FUs, or a lean CRF and in return a higher number of FUs. Finally, we decided upon the lean CRF and the higher number of FUs, in the knowledge that this is a trade-off decision which has its limitation. (3) It is known that a considerable number of recurrences occur much later than 1 year [15]. (4) Preoperative pain (VAS > 0) in the groin was assessed by the patients using the VAS scale. However, the reason for pain was not further examined. Preoperative pain in the groin which was not linked to the hernia might bias the postoperative pain assessment and limit the interpretation of its temporal course.

Statistical methods

The statistical methodology was chosen and performed by an independent statistician. Data was analysed with SPSS (SPSS for Windows, Chicago: SPSS Inc.). For categorical variables the Chi Square test of independence was used while the Student’s t-test was used for continuous variables. Statistical significance was assumed at p-value < 0.05



A total of 164 male patients were included in the study. 135 patients participated throughout the whole follow-up of one-year resulting in a dropout rate of 17.7% (Figure 1).

Patient characteristics (demographics, patient variables as ASA classification and risk factors, type of hernia) and operative date (anaesthesia, duration of surgery, resection of nerves and hernia sac, antibiotic prophylaxis) are listed in Table 1. It is to note that 61% of the patients were classified as ASA II and that 65.9% of the patients were treated as inpatients.

Table 2 lists early postoperative complications within the first 7 days after surgery. At this time point, comparing both sides only the difference of the foreign body sensation was statistically significant favouring the PVDF-side (p < 0.001). The number of recorded seromas and haematomas was lower for the PVDF-side, but not significant.

Table 3 shows late postoperative complications including chronic pain recorded at the 3 months, 6 months and 1 year follow-up. Over the full time period of one year, three recurrences on the PP-side and one on the PVDF-side were recorded. There was no case of mesh migration for both sides. At the 3 months (p = 0.001) and 6 months (p = 0.05) follow-up, there were significantly less patients with chronic pain on the PVDF-side. Both sides had only one patient with chronic pain after one year.

Pain assessment was conducted with a VAS scale as stated above. It was recorded preoperatively and postoperative on the 1st, 3rd, 5th and 7th day as well as the 3rd and 6th month and after one year. The median VAS scores and their standard deviations are shown in Figure 2. The preoperative median VAS scores were 1.8 and 1.9 for the PP-side and the PVDF-side, respectively. As shown in the figure, the median VAS scores for both sides increased more than twice on the first day after surgery and decreased within the first weak reaching almost the preoperative median VAS scores. At the 3-month follow-up median VAS scores for both sides at least halved (PP-side 0.9, PVDF-side 0.7) compared to the preoperative scores. Afterwards, median VAS scores decreased continually till the last follow-up at one year. Significantly lower VAS scores were recorded at the 3-month (p < 0.05) and 6-month (p < 0.05) follow-up for the PVDF-side. At 1 year follow-up the median VAS score for the PVDF-side was half of the PP-side, however it was not statistically significant because of a very low pain level (VAS 0.2 vs 0.4) overall.

Table 1: Patient characteristics and operative data.

  n/N or mean range or %
Patient demographics
male gender 164/164  
age (mean years) 61.5 33-86
Patient variables
ASA I 36/164 22
ASA II 100/164 61
ASA III 28/164 17
Obesity 39/164 24
Smoker 44/164 27
COPD 29/164 18
Hernia variables  
(PP-side -- PVDF-side)  
LI 7 -- 5/164 4.3 -- 3.0
LII 45 -- 48/164 27.4 -- 29.3
LIII 12 -- 12/164 7.3 -- 7.3
MI 9 -- 8/164 5.5 -- 4.9
MII 64 -- 52/164 39.0 -- 31.7
MIII 15 -- 22/164 9.1 -- 13.4
McI 2 -- 4/164 1.2 -- 2.4
McII 8 -- 10/164 4.9 -- 6.1
McIII 2 -- 3/164 1.2 -- 1.8
Operative setting  
in-patient 108/164 65.9
out-patient 56/164 34.1
local 5/164   3
spinal 116/164 70.7
general 43/164 26.2
Operative variables  
(PP-side -- PVDF-side -- bilateral)  
duration of surgery (min) 30.2 -- 29.9 15-55 -- 15 - 55
resection hernia sac 12 -- 3 -- 15/164 7.3 -- 1.8 -- 9.1
resection N. Ilioinguinalis 3 -- 3 -- 16/164 1.8 -- 1.8 -- 9.8
resection N. Hypogastricus 3 -- 3 -- 8/164 1.8 -- 1.8 -- 4.9
resection N. Genitofemoralis 4 -- 9 -- 3/164 2.4 -- 5.5 -- 1.8
antibiotic prophylaxis 164/164 100
trombosis prophylaxis 82/164 50



Despite the progress made in reducing recurrence and pain after inguinal hernia repair these complications are still the major challenges which need to be overcome [1]. Both recurrence and pain are multifactorial problem areas: Patients biological diversity as well as the surgical technique [16,17], are crucial outcome influencing factors. Especially, nerve management [18], and fixation [19], strongly influence pain.The two remaining factors are the polymer (PP vs. PVDF) and the porosity (49%vs. 73%). The study design does not allow investigating one of these two factors individually.The present study design aims to limit the multifactorial problem to a minimum of remaining influencing factors. In this respect, the most effective measures are a standardized surgical procedure, a randomization and the use of both meshes, which are compared, in the same patient. Focus of the present study was to investigate the influence of the used mesh implant. However, the “mesh implant” itself poses a multifactorial issue. The two major mesh properties which influence the clinical performance are the used raw-material (polymer) and the mesh design (porosity, filament structure (mono- vs. multifilament) and mechanical strength). The two mesh implants used in the study were chosen with the goal to limit these factors to a minimum.According to the international groin hernia guidelines a tensile strength of 16 N/cm fulfils the requirement of a mesh implant used in groin hernia repair. Regarding this criterion both meshes used for this study fulfil this requirement. Thus, mechanical strength should not present an influencing factor in this study. Neither should the filament structure have an influence, since both meshes are made from monofilaments with approximately the same thickness (PVDF: 130 µm vs. PP: 140 µm). The two remaining factors are the polymer (PP vs. PVDF) and the porosity (49% vs. 73%). The study design does not allow investigating one of these two factors individually.

In terms of the early postoperative complication (7 days after surgery) foreign body sensation was significantly higher on the PP-side compares to the PVDF-side. Each mesh implantation induces a foreign-body reaction leading to an encapsulation of the polymer filaments by a granuloma of inflammatory and fibrotic cells which is finally related to scar formation [1]. It is known that both polymer and porosity affect the granuloma size and respectively scar formation. In contrast to PVDF, PP triggers a higher foreign body reaction [7,8]. Regarding porosity it is known that small pore meshes foster the bridging effect [20], which leads excessive scar formation combined with higher foreign body sensation [21]. In case of the PP mesh implants used in this study, both described effects sum up. Therefore, the results of the study regarding foreign body sensation are in good accordance with published evidence about foreign body reaction and porosity.

At the 3 and 6 months follow-up the PP-side shows significantly higher late postoperative pain and chronic pain than the PVDF-side. Re-innervation and neo-innervation are known to occur following hernia repairs in indigenous tissue as well as through mesh implants. Bendavid et al., could show that mesh innervation is significantly higher for chronic pain patients [22]. As a consequence, innervation in none-indigenous tissue like granuloma and scar tissue, is the problem. Thus, it might be assumed that pronounced scar formation fosters pain and chronic pain. Taking these considerations into account, the explanation for the observed higher incidence of pain on the PP-side is based on the same principles as discussed above: a polymer with lower biocompatibility which triggers a higher foreign body reaction in combination with a small pore mesh that leads to an excessive scar formation. In consequence these two factors combined lead to a higher incidence of pain. These findings are confirmed by other studies using Lichtenstein and comparing small and large pore meshes [23-25]. Also these studies show advantages for large pore meshes during the first postoperative weeks and 3 months with regard to pain.

Table 2: Early postoperative complications (follow-up: 7th day).

  PP-side PVDF-side p-value bilateral
seroma 7 (4.9%) 3 (2.1%) 0.198 2 (1.4%)
haematoma 11 (7.6%) 5 (3.5%) 0.123 62 (43.1%)
infection 0 (0.0%) 1 (0.7%)     - 0 (0.0%)
early recurrence 0 (0.0%) 0 (0.0%)     - 0 (0.0%)
foreign body sensation 32 (22.2%) 8 (5.6%) <0.001 38 (26.4%)
numbness 36 (25.0%) 31 (21.5%) 0.486 29 (20.1%)

Table 3: Late postoperative complications including chronic pain.

follow-up   PP-side PVDF-side p-value bilateral
3 months recurrence 1 (0.7%) 0 (0.0%)    - 0 (0.0%)
  mesh migration 0 (0.0%) 0 (0.0%)    - 0 (0.0%)
  chronic pain VAS>4 15 (10.3%) 2 (1.4%) 0.001 5 (3.4%)
  numbness 5 (3.4%) 12 (8.3%) 0.08 22 (15.2%)
6 months recurrence 1 (0.7%) 1 (0.7%)    - 0 (0.0%)
  mesh migration 0 (0.0%) 0 (0.0%)    - 0 (0.0%)
  chronic pain VAS>4 8 (5.7%) 2 (1.4%) 0.05 2 (1.4%)
  numbness 6 (4.3%) 3 (2.1%) 0.25 4 (2.9%)
1 year recurrence 1 (0.7%) 0 (0.0%)    - 0 (0.0%)
  mesh migration 0 (0.0%) 0 (0.0%)    - 0 (0.0%)
  chronic pain VAS>4 1 (0.7%) 1 (0.7%) 0.751 2 (1.5%)
  numbness 2 (1.5%) 2 (1.5%) 0.689 3 (2.2%)



Analysis of the primary and secondary outcome parameters of this study show that both meshes (DynaMesh-LICHTENSTEIN and Surgipro) can be safely used for inguinal hernia repair. However, the PVDF-mesh performed considerably better in terms of immediate foreign body sensation (up to 7 days post surgery), late postoperative pain and chronic pain, which influences patients’ quality of life directly. We also recorded fewer recurrences over the full follow-up period for the PVDFmesh. Because of these findings, we conclude that PVDF large pore meshes are preferable for the Lichtenstein repair compared to PP small pore meshes.

A five-year follow-up might be considered to get valid insights about the course of pain as well as the long-term recurrence rate


1. The Hernia Surge Group. International guidelines for groin hernia management. Hernia. 2018; 22: 1-165.

2. Cybu?ka B. Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective casecontrol study. Pol Przegl Chir. 2017; 89: 11-25.

3. Bringman S, Wollert S, Osterberg J. Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg. 2006; 93: 1056-1059.

4. Hoyuela C, Juvany M, Carvajal F, Veres A, Troyano D, Trias M, et al. Randomized clinical trial of mesh fixation with glue or sutures for Lichtenstein hernia repair. Br J Surg. 2017; 104: 688-694.

5. Nikkolo C, Vaasna T, Murruste M. Three-Year Results of a SingleCentre Single-Blinded Randomised Study Evaluating the Impact of Mesh Pore Size on Chronic Pain after Lichtenstein Hernioplasty. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc. 2016; 105: 141-146.

6. Amid PK. Lichtenstein tension-free hernioplasty: Its inception, evolution, and principles. Hernia. 2004; 8: 1-7.

7. Klink CD, Junge K, Binnebösel M, Alizai HP, Otto J, Neumann UP, et al. Comparison of long-term biocompability of PVDF and PP meshes. J Investig Surg. 2011; 24: 292-299.

8. Conze J, Junge K, Weiss C, Anurov M, Oettinger A, Klinge U, et al. New polymer for intra-abdominal meshes--PVDF copolymer. J Biomed Mater Res B Appl Biomater. 2008; 87: 321-328.

9. Laroche G, Marois Y, Schwarz E, Guidoin R, King MW, Pâris E, et al. Polyvinylidene fluoride monofilament sutures: can they be used safely for long-term anastomoses in the thoracic aorta? Artif Organs. 1995; 19: 1190-1199.

10. Silva RA, Silva PA, Carvalho ME. Degradation studies of some polymeric biomaterials: Polypropylene (PP) and polyvinylidene difluoride (PVDF). In: Chandra T, Tsuzaki K, Militzer M, Ravindran C, editors. THERMEC 2006, Pts 1-5. Trans Tech Publications Ltd, StafaZurich. 2007; 573-576.

11. Costello CR, Bachman SL, Ramshaw BJ, Grant SA. Materials characterization of explanted polypropylene hernia meshes. J Biomed Mater Res B Appl Biomater. 2007; 83: 44-49.

12. Mary C, Marois Y, King MW, Laroche G, Douville Y, Martin L, et al. Comparison of the in vivo behavior of polyvinylidene fluoride and polypropylene sutures used in vascular surgery. ASAIO J. 1998; 44: 199-206.

13. Sternschuss G, Ostergard DR, Patel H. Post-implantation alterations of polypropylene in the human. J Urol. 2012; 188: 27-32.

14. Schumpelick V. Kurzlehrbuch Chirurgie: 181 Tabellen, 7., korrigierte Aufl. Thieme, Stuttgart. 2006.

15. Köckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W. How Long Do We Need to Follow-Up Our Hernia Patients to Find the Real Recurrence Rate? Front Surg. 2015; 2: 24.

16. Lange JFM, Kaufmann R, Wijsmuller AR, Pierie JP, Ploeg RJ, Chen DC, et al. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia. 2015; 19: 33-43.

17. Nikkolo C, Lepner U. Chronic pain after open inguinal hernia repair. Postgrad Med. 2016; 128: 69-75.

18. Bischoff JM, Aasvang EK, Kehlet H, Werner MU. Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? Hernia J. 2012; 16: 573-577.

19. Ismail A, Abushouk AI, Elmaraezy A, Abdelkarim AH, Shehata M, Abozaid M, et al. Self-gripping versus sutured mesh fixation methods for open inguinal hernia repair: A systematic review of clinical trials and observational studies. Surgery. 2017; 162: 18-36

20. Mühl T, Binnebösel M, Klinge U, Goedderz T. New objective measurement to characterize the porosity of textile implants. J Biomed Mater Res B Appl Biomater. 2008; 84: 176-183.

21. Klinge U, Klosterhalfen B. Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia. 2012; 16: 251-258.

22. Bendavid R, Lou W, Grischkan D, Koch A, Peterson K, Morrison J, et al. A mechanism of mesh-related post-herniorrhaphy neuralgia. Hernia J Hernias Abdom Wall Surg. 2016; 20: 357-365.

23. The Polish Hernia Study Group, Bury K, ?mieta?ski M. Five-year results of a randomized clinical trial comparing a polypropylene mesh with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty. Hernia. 2012; 16: 549-553.

24. Nikkolo C, Vaasna T, Murruste M, Seepter H, Kirsimägi Ü, Lepner M. Randomized clinical study evaluating the impact of mesh pore size on chronic pain after Lichtenstein hernioplasty. J Surg Res. 2014; 191: 311-317.

25. Pielaci?ski K, Szczepanik AB, Wróblewski T. Effect of mesh type, surgeon and selected patients’ characteristics on the treatment of inguinal hernia with the Lichtenstein technique. Randomized trial. Videosurgery Miniinvasive Tech. 2013; 2: 99-106.


Introduction: In the past decades tension-free inguinal hernia repair using prosthetic meshes has become the procedure of choice. Recurrence rates could be reduced, but still remain one of the major complications. Another major problem is pain of which both acute and chronic pain can influence the patients’ quality of life directly.

Material and methods: We conducted a single blinded multicenter randomized trial with 164 patients treated for primary bilateral inguinal hernia with a total follow-up period of one year. The open tension-free Lichtenstein technique as described by Amid was used as standardized procedure. In each patient, we used two different meshes. The Surgipro® is composed of polypropylene (PP) and the DynaMesh®-LICHTENSTEIN of polyvinylidene fluoride (PVDF). This approach allowed us to investigate pain, chronic pain and other postoperative complications in dependence of the used mesh.

Results: Overall, both biomaterials performed well over the full follow-up period of one year, but the DynaMesh-LICHTENSTEIN was significantly better in terms of late postoperative pain and chronic pain at 3-months and 6-months follow-up compared to the Surgipro. Throughout the whole follow-up of one year, we recorded a single recurrence for the PVDF mesh and three recurrences for the PP mesh.

Conclusion: Data from this study suggests that the use of large pore PVDF meshes is preferable compared to PP small pore meshes because it significantly decreases pain and chronic pain up to 6 months after surgery and acute foreign body sensation. After one year, there are still differences in pain but these are no more significant.


García-Pastor P, Hidalgo M, Gutierrez R, Picazo J, lopart RL, et al. (2018) Prospective Multicenter Blinded Randomized Study Comparing PP and PVDF Mesh Implants in Lichtenstein Procedure with Respect to Pain and Recurrence. JSM Surg Proced 1(1): 1002


•    Lichtenstein procedure
•    Bilateral inguinal hernia
•    Recurrence
•    Pain
•    PVDF
•    Mesh implant

García-Pastor P, Hidalgo M, Gutierrez R, Picazo J, lopart RL, et al. (2018) Prospective Multicenter Blinded Randomized Study Comparing PP and PVDF Mesh Implants in Lichtenstein Procedure with Respect to Pain and Recurrence. JSM Surg Proced 1(1): 1002.

Received : 05 Jan 2018
Accepted : 18 Mar 2018
Published : 20 Mar 2018
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
TEST Journal of Dentistry
ISSN : 1234-5678
Launched : 2014
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X