Fixation versus no fixation in laparoscopic totally extraperitoneal repair of primary inguinal hernia-a systematic review and meta-analysis of randomized controlled trials.

Langenbeck's Archives of Surgery
Shaheel Mohammad SaheballyDesmond Winter

Abstract

The necessity of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. We performed a systematic review and meta-analysis to compare the effectiveness of mesh fixation versus no fixation in laparoscopic TEP repair for primary inguinal hernia. PubMed, EMBASE, and Cochrane databases were searched for relevant articles from January 1992 until May 2020. All trials that compared fixation versus no fixation in TEP repairs for inguinal herniae were included. Recurrent and femoral herniae were excluded from the current analysis. The primary outcome measure was recurrence while secondary outcomes included postoperative pain at 24 h, mean operative time, urinary retention, and seroma rates. Random effects models were used to calculate pooled effect size estimates. Sensitivity analyses were also carried out. Eight randomized controlled trials were included capturing 557 patients and 715 inguinal herniae. On random effects analysis, there were no significant differences between fixation and no fixation with respect to recurrence (RD 0.00, 95% CI = - 0.01 to 0.01, p = 1.00), operative time (MD 1.58 min, 95% CI = - 0.22 to 3.37, p = 0.09), seroma (OR = 0.70, 95% CI = 0.28 to 1.74, p = 0.44)...Continue Reading

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