Mesh fixation techniques for inguinal hernia repair: An overview of systematic reviews of randomised controlled trials
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Authors
Alabi, A
Haladu, N
Scott, N.W
Imamura, M
Ahmed, I
Ramsay, G
Brazzelli, M
Issue Date
2022
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Surgery::Surgical research::Surgery , Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Gastroenterology
Alternative Title
Abstract
Purpose: Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques.
Methods: We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool.
Results: We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence.
Conclusion: Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect.
Keywords: Hernia repair; Inguinal; Mesh; Overview of systematic reviews.
© 2021. The Author(s).
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Conflict of interest statement
The authors declare that they have no conflict of interest.
Figures
Fig. 1
Fig. 1 PRISMA flow diagram
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Publication types
Review
MeSH terms
Chronic Pain* / etiology
Chronic Pain* / surgery
Hernia, Inguinal* / complications
Hernia, Inguinal* / surgery
Herniorrhaphy / adverse effects
Herniorrhaphy / methods
Humans
Laparoscopy* / adverse effects
Pain, Postoperative / etiology
Pain, Postoperative / prevention & control
Pain, Postoperative / surgery
Randomized Controlled Trials as Topic
Recurrence
Surgical Mesh / adverse effects
Systematic Reviews as Topic
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Citation
Alabi A, Haladu N, Scott NW, Imamura M, Ahmed I, Ramsay G, Brazzelli M. Mesh fixation techniques for inguinal hernia repair: an overview of systematic reviews of randomised controlled trials. Hernia. 2022 Aug;26(4):973-987. doi: 10.1007/s10029-021-02546-x. Epub 2021 Dec 14. PMID: 34905142; PMCID: PMC9334446.
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34905142