Meta‐analysis of postoperative pain using non‐sutured or sutured single‐layer open mesh repair for inguinal hernia

Abstract

Background Chronic postoperative pain occurs in up to 21·7 per cent of patients undergoing open inguinal hernia repair. Several mesh fixation techniques using glue or self‐gripping meshes have been developed to reduce postoperative pain. The aim of this meta‐analysis was to evaluate RCTs comparing adhesional/self‐gripping and sutured single‐layer open mesh fixations in the repair of inguinal herniation, with postoperative pain as endpoint. Methods PubMed, Embase and Cochrane CENTRAL databases were searched systematically for RCTs according to the PRISMA guidelines; the study was registered at PROSPERO (CRD42017056373). Different fixation methods were analysed. The primary outcome, chronic pain, was defined as a postoperative visual analogue scale (VAS) score of at least 3 at 12 months. Secondary outcomes were mean VAS score at 1 week and at 1 month after surgery. Results Twenty‐three studies including 5190 patients were included in the meta‐analysis. Adhesional (self‐adhering or glued) or self‐gripping fixation methods were associated with a significantly lower VAS score at 1 week (mean difference –0·49, 95 per cent c.i. ‐0·81 to –0·17; P = 0·003) and at 1 month (mean difference –0·31, –0·58 to –0·04; P = 0·02) after surgery than suture fixation, but the incidence of chronic pain after 12 months was similar in the two groups (odds ratio 0·70, 95 per cent c.i. 0·30 to 1·66). Differences in recurrences and complications between groups did not reach statistical significance. Conclusion There was no difference in the incidence of chronic pain 12 months after different mesh repair fixation techniques despite significant reductions in short‐term postoperative pain favouring a non‐sutured technique. There were no differences in recurrence rates or in rates of other complications at 1 year.

Mesh fixation techniques for inguinal hernia repair: an overview of systematic reviews of randomised controlled trials

“…Eleven of the included reviews summarised the evidence of different mesh fixation techniques in open inguinal hernia repairs, [16,[24][25][26][27][28][29][31][32][33][34]; eight reported mesh fixation in laparoscopic inguinal hernia repairs [14,15,17,18,30,[35][36][37] and one review reported mesh fixation in both open and laparoscopic repairs [38].…”

“…For open mesh repairs, six systematic reviews compared glue fixation with suture. [16,25,26,28,32,33] and five of them included a meta-analysis. [16,25,26,28,32] Meta-analysis results across reviews tended to indicate that glue fixation has a lower risk of chronic pain compared with suture, and two systematic reviews, one at low risk of bias [28] and one at high risk of bias, [32] reported statistically significant differences in the short-term [3-6 months after surgery] [OR 0.63; 95% CI 0.44 to 0.91 and RR 0.52; 95% CI 0.31 to 0.87, respectively].…”

“…[16,25,26,28,32,33] and five of them included a meta-analysis. [16,25,26,28,32] Meta-analysis results across reviews tended to indicate that glue fixation has a lower risk of chronic pain compared with suture, and two systematic reviews, one at low risk of bias [28] and one at high risk of bias, [32] reported statistically significant differences in the short-term [3-6 months after surgery] [OR 0.63; 95% CI 0.44 to 0.91 and RR 0.52; 95% CI 0.31 to 0.87, respectively]. One review of moderate quality [26] that assessed chronic pain at 5 years did not find a statistically significant difference between glue and suture fixation in the long-term (OR 0.62; 95% CI 0.32 to 1.19).…”

“…Five systematic reviews compared self-gripping mesh with suture and found no significant differences in chronic pain between the two fixation techniques. [24,25,27,31,33] Similarly, one review comparing self-gripping mesh with glue [24] and another review comparing mechanical fixation (tack) with suture fixation for open mesh repair [33] reported comparable rates of chronic pain between fixation techniques. However, most of these reviews reported wide confidence intervals (CIs) around the summary estimate of effect, and clinically important effects favouring either technique for mesh fixation cannot be ruled out with certainty (Table 3).…”

Self-gripping Mesh in Inguinal Hernia Repair

“…Inguinal hernia repair is one of the most frequent procedures a general surgeon performs. Various surgeons have contributed to different techniques for a better outcome in relation to different complications like groin pain, infection, testicular atrophy and recurrence etc., related to older techniques [2] .…”