“…Figures 2 and 3 display the results of the quality assessment. Attrition bias and reporting bias were high in all 18 studies except in the study by Smith et al 9 The blinding of both participants and personnel and that of outcome assessors were only fully described by Garg et al 15 and Yildirim et al 17 Ayyaz et al 18 divided participants using the lottery method into even and odd which was considered to involve a high risk of selection bias, whereas proper random sequence generation was explicitly described in 12 articles and omitted in 5 studies. Allocation concealment was conducted appropriately in 11 reports and unclear in the remaining records.Figure 2.Risk of bias summary.Figure 3.Risk of bias graph.…”
Section: Resultsmentioning
confidence: 99%
“…27 While the nonfixation technique is an ideal way to avoid harm to the nerves, mesh fixation is a good method to reduce mesh slippage and therefore decrease the incidence of recurrence. 28 An in vitro study, sponsored by a company, verified the mesh displacement hypothesis 28 ; on the contrary, several in vivo trials 8,17 have refuted it. Nonetheless, all agree that a mesh of appropriate size to obtain sufficient periorifice overlap is of vital significance.…”
Background It remains controversial whether mesh should be fixed during laparoscopic inguinal hernia repair. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare fixation and nonfixation in laparoscopic groin hernia repair. Methods A registration was listed with PROSPERO (International Prospective Register of Systematic Reviews; registration no. CRD42022350469). Databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched to identify RCTs comparing fixation with nonfixation in laparoscopic groin hernia repair. The primary outcomes were postoperative pain at 24 hours and recurrence. Secondary outcomes were mean operative time, urinary retention, and postoperative pain at 6 months. Results A total of 18 trials, including 2617 patients with 2878 hernias, were included in this meta-analysis. In contrast to the fixation group, the nonfixation group was associated with lower postoperative pain scores at 24 hours and 6 months, a shorter mean operative time, and a lower incidence of urinary retention. There were no significant differences between the 2 types of procedures in terms of the rate of recurrence for patients with an inguinal hernia orifice smaller than 4 cm in size. Conclusions The nonfixation technique is an effective method to reduce urinary retention, mean operative time, and postoperative pain at 24 hours and at 6 months; however, the rate of recurrence was comparable to that of the fixation method.
“…Figures 2 and 3 display the results of the quality assessment. Attrition bias and reporting bias were high in all 18 studies except in the study by Smith et al 9 The blinding of both participants and personnel and that of outcome assessors were only fully described by Garg et al 15 and Yildirim et al 17 Ayyaz et al 18 divided participants using the lottery method into even and odd which was considered to involve a high risk of selection bias, whereas proper random sequence generation was explicitly described in 12 articles and omitted in 5 studies. Allocation concealment was conducted appropriately in 11 reports and unclear in the remaining records.Figure 2.Risk of bias summary.Figure 3.Risk of bias graph.…”
Section: Resultsmentioning
confidence: 99%
“…27 While the nonfixation technique is an ideal way to avoid harm to the nerves, mesh fixation is a good method to reduce mesh slippage and therefore decrease the incidence of recurrence. 28 An in vitro study, sponsored by a company, verified the mesh displacement hypothesis 28 ; on the contrary, several in vivo trials 8,17 have refuted it. Nonetheless, all agree that a mesh of appropriate size to obtain sufficient periorifice overlap is of vital significance.…”
Background It remains controversial whether mesh should be fixed during laparoscopic inguinal hernia repair. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare fixation and nonfixation in laparoscopic groin hernia repair. Methods A registration was listed with PROSPERO (International Prospective Register of Systematic Reviews; registration no. CRD42022350469). Databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched to identify RCTs comparing fixation with nonfixation in laparoscopic groin hernia repair. The primary outcomes were postoperative pain at 24 hours and recurrence. Secondary outcomes were mean operative time, urinary retention, and postoperative pain at 6 months. Results A total of 18 trials, including 2617 patients with 2878 hernias, were included in this meta-analysis. In contrast to the fixation group, the nonfixation group was associated with lower postoperative pain scores at 24 hours and 6 months, a shorter mean operative time, and a lower incidence of urinary retention. There were no significant differences between the 2 types of procedures in terms of the rate of recurrence for patients with an inguinal hernia orifice smaller than 4 cm in size. Conclusions The nonfixation technique is an effective method to reduce urinary retention, mean operative time, and postoperative pain at 24 hours and at 6 months; however, the rate of recurrence was comparable to that of the fixation method.
“…However, mesh fixation during TEP inguinal hernia repair remains controversial. Several randomised controlled trials (RCTs) had failed to demonstrate the advantage of mesh fixation in terms of mesh displacement and recurrence 9 10. Two meta-analyses of six RCTs further demonstrated that non-fixation of meshes is a safe alternative that does not significantly increase the risk of recurrence 11 12.…”
With increasing utilisation of meshes in inguinal hernia repair, reports of mesh-related complications are emerging, particularly late visceral complications, with mesh migration and erosion into the small bowel, bladder and colon reported after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. We present a case of spontaneous mesh migration through the superficial inguinal ring with skin erosion following TEP inguinal hernia repair, the first published report in the literature to our knowledge. This case highlights the difficulty in diagnosis due to the long latent period of hernia repair and the onset of erosion. A high index of suspicion is required when diagnosing any patient who presents with an unexplained groin abscess following ipsilateral TEP repair. CT scan should be performed early for diagnosis and assessment. Removal of the migrated portion of the mesh, antibiotic therapy and secondary wound closure are strategies for the successful treatment of this complication.
“…It has been adopted by an increasing number of surgeons and has quickly become the most popular technique for repairing inguinal hernia. 3 The key to tension‐free hernia repair lies in the use of an artificial mesh. However, mesh use also brings new complications, such as surgical site infection.…”
Section: Introductionmentioning
confidence: 99%
“…This surgical method has the advantages of less surgical trauma, less postoperative pain and rapid recovery. It has been adopted by an increasing number of surgeons and has quickly become the most popular technique for repairing inguinal hernia 3 . The key to tension‐free hernia repair lies in the use of an artificial mesh.…”
Whether to use antibiotics to prevent surgical site infection in elective inguinal tension‐free hernia repair has been controversial. To systematically evaluate the effect of prophylactic antibiotic application in elective inguinal tension‐free hernia repair, we identified all published randomised controlled trials of the effect of prophylactic antibiotic application on elective inguinal tension‐free hernia repair were collected by computer retrieval from the China National Knowledge Infrastructure; VIP Database; Wanfang Database; China Biomedical Literature Database; and PubMed, EMBASE and Cochrane Library databases. Meta‐analysis was performed by RevMan 5.3 software. The meta‐analysis showed that the total incidence of surgical site infections [
P
= 0.003] and the incidence of superficial surgical site infections [
P
= 0.004] in the antibiotic group (AG) were lower than those in the non‐antibiotic group (NAG). There was no significant difference in the total incidence of postoperative infections [
P
= 0.06], deep surgical site infections [
P
= 0.26] and seroma [
P
= 0.52] between the AG and the NAG. Based on current evidence, the application of prophylactic antibiotics in elective inguinal tension‐free hernia repair can prevent the total incidence of surgical site infections and that of superficial surgical site infections but cannot prevent the total incidence of postoperative infection events, incidence of deep surgical site infections and incidence of seroma.
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