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. 2023 Oct 30:16:138-147.
doi: 10.1016/j.sopen.2023.10.006. eCollection 2023 Dec.

Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials

Hui Dong  1 , Li Li  2 , Hui-He Feng  1 , Deng-Chao Wang  1
Affiliations

Safety of unfixed mesh in laparoscopic total extraperitoneal inguinal hernia repair: A meta-analysis of randomized controlled trials

Hui Dong et al. Surg Open Sci. .

Abstract

Background: Whether the effect of the unfixed mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair can lead to hernia recurrence remains controversial.

Methods: The PubMed, Cochrane Library, and EMBASE databases were searched to retrieve clinical randomized controlled trials (RCTs) comparing nonfixation of mesh and fixation of mesh in TEP inguinal hernia repair, and we performed a metaanalysis with RevMan 5.3 software.

Results: Fifteen RCTs were included in the metaanalysis, which showed that the operation time (P = 0.001) of the unfixed mesh group was shorter than that of the fixed mesh group; additionally, the postoperative 24-h pain score (P = 0.04) and incidence of urinary retention (P = 0.001) were lower in the unfixed mesh group. There was no significant difference between the unfixed mesh group and the fixed mesh group in terms of hospital stay (P = 0.47), time to resume normal activities (P = 0.51), incidence of haematoma (P = 0.96), incidence of chronic pain (P = 0.20), and recurrence rate (P = 0.09).

Conclusion: Unfixed mesh in TEP inguinal hernia repair shows no elevated recurrence rates compared to fixed mesh and is clinically safe.

Keywords: Inguinal hernia; Laparoscopic; Mesh fixation; Meta-analysis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Study selection.
Fig. 2
Fig. 2
Risk of bias graph for randomized controlled trials included in this study.
Fig. 3
Fig. 3
Summary of the risk of bias analysis for the randomized controlled trials included in this study.
Fig. 4
Fig. 4
Comparison of operation time between the two groups.
Fig. 5
Fig. 5
Comparison of pain score 24 h after surgery between the two groups.
Fig. 6
Fig. 6
Comparison of hospital stay between the two groups.
Fig. 7
Fig. 7
Comparison of days to normal activities between the two groups.
Fig. 8
Fig. 8
Comparison of incidence of haematoma between two groups.
Fig. 9
Fig. 9
Comparison of the incidence of urinary retention between the two groups.
Fig. 10
Fig. 10
Comparison of the incidence of chronic pain between the two groups.
Fig. 11
Fig. 11
Comparison of recurrence rates between the two groups.
Fig. 12
Fig. 12
Inverted funnel plot.
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