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A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair

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Abstract

Background

Mesh fixation during laparoscopic total extraperitoneal (TEP) inguinal hernia repair is still controversial. Although many surgeons considered it necessary to fix the mesh, some published studies supported elimination of mesh fixation. Therefore, a meta-analysis based on randomized controlled trials (RCTs) was conducted to compare the effectiveness and safety of fixation versus nonfixation of mesh in TEP.

Methods

RCTs were identified from PubMed, Embase, the Cochrane Library, SCI, and the Chinese Biomedical Literature Database (CBM). Two reviewers assessed the quality of the studies and extracted data independently. The methodological quality was evaluated according to the Cochrane Handbook 5.0.2. Statistical analysis was conducted using the Cochrane software RevMan 5.0.21.

Results

Six RCTs involving 772 patients were included. The nonfixation group had advantages in length of hospital stay [MD =−0.37, 95% CI (−0.57, −0.17), p = 0.0003], operative time [MD = −4.19, 95% CI (−7.77, −0.61), p = 0.02], and costs. However, there was no statistically significant difference in hernia recurrence [OR = 2.01, 95% CI (0.37, 11.03), p = 0.42], time to return to normal activities [MD = −0.13, 95% CI (−0.45, 0.19), p = 0.43], seroma [OR = 1.25, 95% CI (0.30, 5.18), p = 0.75], and postoperative pain on postoperative day 1 [MD = −0.21, 95% CI (−0.52, 0.10), p = 0.18] and day 7 [MD = −0.11, 95% CI (−0.42, 0.20), p = 0.47].

Conclusions

Without increasing the risk of early hernia recurrence, the nonfixation of mesh in TEP appears to be a safe alternative that is associated with less costs, shorter operative time, and hospital stay for the selected patients. Further adequately powered RCTs are required to clarify whether mesh fixation is necessary for the patients with different types of hernias and larger hernia defects.

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Acknowledgments

The authors are grateful to Sandi Robinson (USA) and Xubin Liu (China) for the assistance in the writing and editing of the manuscript.

Disclosures

Drs. Yuan Jun Teng, Shu Mei Pan, Ya Li Liu, Ke Hu Yang, You Cheng Zhang, Jin Hui Tian, and Jian Xu Han have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Dong Gang West Road No. 199, Chengguan, Lanzhou, Gansu, 730000, China

    Yuan Jun Teng, Shu Mei Pan, Ya Li Liu, Ke Hu Yang, Jin Hui Tian & Jian Xu Han

  2. The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China

    Yuan Jun Teng & Shu Mei Pan

  3. The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China

    Ke Hu Yang & Jian Xu Han

  4. Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China

    You Cheng Zhang

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  1. Yuan Jun Teng
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Correspondence to Ya Li Liu.

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Teng, Y.J., Pan, S.M., Liu, Y.L. et al. A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair. Surg Endosc 25, 2849–2858 (2011). https://doi.org/10.1007/s00464-011-1668-3

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