Mesh fixation techniques in Lichtenstein tension‐free repair: a network meta‐analysis

Abstract

Backgrounds: To compare the clinical effectiveness of different mesh fixation techniques in Lichtenstein tension-free repair using network meta-analysis. Methods: Cochrane Library, Medline, EMBASE, and Web of Science databases were searched until 1 December 2020, and randomized controlled trials (RCTs) comparing outcomes between different mesh fixation techniques were included. The primary endpoints were chronic postoperative inguinal pain (CPIP) and hernia recurrence. The second endpoint was seroma and infection. Data were processed using Stata MP16.0, and R x64 3.6.1. Results: The results demonstrated that 32 RCTs (n = 6362) were eligible for pooling. Six types of mesh fixation techniques were used: non-absorbable suture, absorbable suture, chemical glue, fibrin glue, self-gripping mesh, and staple fixation. Network meta-analysis indicated that the incidence of CPIP with fibrin glue was lower than that with nonabsorbable sutures (relative risk [RR] = 0.23, 95% credibility interval [95%CrI] [0.09, 0.50]), absorbable sutures (RR = 0.24, 95%CrI [0.08, 0.60]), chemical glue (RR = 0.36, 95%CrI [0.13, 0.87]), and self-gripping mesh (RR = 0.27 95%CrI [0.09, 0.62]). Selfgripping mesh was superior to non-absorbable sutures (RR = 0.44, 95%CrI [0.23, 0.74]) in reducing postoperative infection. Conclusion: This network meta-analysis suggests that fibrin glue might be best for reducing CPIP and recurrence. However, a large-scale RCT is warranted to confirm the results. MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement for this systematic review and network meta-analysis. The study protocol was registered on PROSPERO (CRD42021231978).

Cost-effectiveness analysis of mesh fixation techniques for laparoscopic and open inguinal hernia surgeries

“…The current meta-analysis evidence of mesh fixation in OHR suggested that glue was superior to suture mesh at shorter operative time and reduced pain, but had no effect on long-term hernia recurrence, while chronic groin pain was equivocal. For SGM, no difference was found in the use of mesh fixation compared to suture or compared to flat mesh itself [9][10][11][12][13][14][15][16][17][18][19][32][33][34]. In LHR, glue was more useful than tack in reducing chronic groin pain, but there was no difference in hernia recurrence [34][35][36][37][38][39][40].…”

“…For SGM, no difference was found in the use of mesh fixation compared to suture or compared to flat mesh itself [9][10][11][12][13][14][15][16][17][18][19][32][33][34]. In LHR, glue was more useful than tack in reducing chronic groin pain, but there was no difference in hernia recurrence [34][35][36][37][38][39][40]. There is no SGM information for LHR.…”

Impact of different fibrin glue application methods on inguinal hernia mesh fixation capability

“…In open inguinal hernia operations, especially those utilizing the Lichtenstein method, various studies have suggested that fibrin glue is an effective alternative to sutures in reducing invasiveness [1][2][3][4][5][6] . In endoscopic hernia repair, there is a growing trend towards avoiding invasiveness by not fixing the mesh, as recommended by guidelines from the HerniaSurge Group 7 .…”

Impact of different fibrin glue application methods on hernia mesh fixation capability

“…Therefore, there has been a shift in research focus toward reducing complication rates, which led to an increased interest in less invasive mesh xation methods. More studies have reported the e cacy of brin glue for inguinal hernias in clinical settings [8][9][10][11][12][13][14][15][16]. Further, basic research comparing xation capabilities between brin glue and tacks or staples and studies on meshes that are compatible with brin glue are advancing [17][18][19][20][21][22][23][24].…”