Open Inguinal Hernia Repair: A Network Meta‐analysis Comparing Self‐Gripping Mesh, Suture Fixation, and Glue Fixation

Abstract

The most troublesome complications of inguinal hernia repair are recurrent herniation and chronic pain. A multitude of technological products dedicated to abdominal wall surgery, such as self‐gripping mesh (SGM) and glue fixation (GF), were introduced in alternative to suture fixation (SF) in the attempt to lower the postoperative complication rates. We conducted an electronic systematic search using MEDLINE databases that compared postoperative pain and short‐ and long‐term surgical complications after SGM or GF and SF in open inguinal hernia repair. Twenty‐eight randomized controlled trials totaling 5495 patients met the inclusion criteria and were included in this network meta‐analysis. SGM and GF did not show better outcomes in either short‐ or long‐term complications compared to SF. Patients in the SGM group showed significantly more pain at day 1 compared to those in the GF group (VAS score pain mean difference: − 5.2 Crl − 11.0; − 1.2). The relative risk (RR) of developing a surgical site infection (RR 0.83; Crl 0.50–1.32), hematoma (RR 1.9; Crl 0.35–11.2), and seroma (RR 1.81; Crl 0.54–6.53) was similar in SGM and GF groups. Both the SGM and GF had a significantly shorter operative time mean difference (1.70; Crl − 1.80; 5.3) compared to SF. Chronic pain and hernia recurrence did not statistically differ at 1 year (RR 0.63; Crl 0.36–1.12; RR 1.5; Crl 0.52–4.71, respectively) between SGM and GF. Methods of inguinal hernia repair are evolving, but there remains no superiority in terms of mesh fixation. Ultimately, patient’s preference and surgeon’s expertise should still lead the choice about the fixation method.

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].…”

“…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).…”

Laparoscopic totally extra‐peritoneal groin hernia repair with self‐gripping polyester mesh: a series of 780 repairs

“…There is weak evidence that lightweight, large pore mesh may reduce the incidence of chronic pain and foreign body related discomfort . Another dimension to the complexity of the issue is the use of mesh fixation devices . Complications of fixation such as migration, recurrence and chronic pain have ensured that this also is an area of considerable debate .…”

Mesh fixation technique for inguinal hernia repair: protocol for an umbrella review with integrated and updated network meta-analysis

“…Several techniques for mesh fixations have been used including suture, glue or self-gripping mesh for open hernia repair (OHR); metallic tack, absorbable tack, glue, suture, self-gripping mesh or even non-fixation techniques for laparoscopic hernia repair (LHR). Up to date, there have been eight systematic reviews and meta-analyses (SRMAs) on OHR8–15 (ie, glue vs suture (n=5)8 9 11 12 14 and self-gripping mesh vs suture (n=3))10 13 15 and one network meta-analysis (NMA) 16. For LHR, comparisons were tack and glue (n=6),17–22 fixation versus no fixation (n=4)23–25 and one NMA26.…”

“…Although evidences were interesting, the overall results were inconclusive, that is, five SRMAs suggested non-superiority in self-gripping mesh among all mesh fixations in OHR,10 13 15 16 27 whereas five SRMAs favoured glue fixation in decreasing postoperative pain 8 9 11 12 14. Among LHR, three SRMAs favoured glue fixation to decrease postoperative pain,17 18 20 three SRMAs favoured no mesh fixation23–25 and one meta-study suggested all mesh fixations were comparable 19.…”