No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials,Surgical Endoscopy

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No evidence for fixation of mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2023-09-06 , DOI: 10.1007/s00464-023-10237-0
K A Riemenschneider _{1,

2} , H Lund ₂ , H C Pommergaard ₁

Affiliation

Objective

To investigate the differences in hernia recurrence and chronic postoperative inguinal pain (CPIP) in randomized, controlled trials comparing fixation and non-fixation of the mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.

Methods

A multi-database systematic search was conducted for randomized, controlled trials comparing fixation versus non-fixation of the mesh in TAPP inguinal hernia repair. All eligible papers were assessed for risk of bias using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Quality of evidence was evaluated using the GRADE system. Meta-analyses were performed regarding recurrence and CPIP using RevMan.

Results

Seven prospective, randomized controlled trials were included. Laparoscopic TAPP inguinal hernia repair was performed in 1732 patients with 737 procedures performed without fixation and 995 procedures with fixation of the mesh. Despite all trials being RCTs, the trials were limited by substantial bias and the quality of evidence was low regarding hernia recurrence and very low regarding CPIP. Pooled estimates from meta-analyses were an OR of 2.80 (95% CI 0.61–12.77) for hernia recurrence and a mean difference in visual analogue scale (VAS) of 0.17 (95% CI 0.90–1.24) for CPIP, respectively.

Conclusion

The current evidence is very uncertain and mesh fixation may have little to no effect regarding hernia recurrence and chronic postoperative inguinal pain in patients operated with TAPP inguinal hernia repair.

中文翻译：

没有证据表明腹腔镜经腹腹膜前 (TAPP) 腹股沟疝修补术中网片固定：随机对照试验的系统评价和荟萃分析

客观的

目的在比较腹腔镜经腹腹膜前 (TAPP) 腹股沟疝修补术中固定和不固定补片的随机对照试验中，探讨疝气复发和慢性术后腹股沟疼痛 (CPIP) 的差异。

方法

对 TAPP 腹股沟疝修补术中固定与非固定补片进行比较的随机对照试验进行了多数据库系统搜索。使用修订后的 Cochrane 随机试验偏倚风险工具 (RoB 2.0) 评估所有符合条件的论文的偏倚风险。使用 GRADE 系统评估证据质量。使用 RevMan 对复发和 CPIP 进行荟萃分析。

结果

其中包括七项前瞻性随机对照试验。对 1732 名患者进行了腹腔镜 TAPP 腹股沟疝修补术，其中 737 例手术未进行固定，995 例手术进行了网片固定。尽管所有试验都是随机对照试验，但这些试验受到重大偏倚的限制，并且关于疝气复发的证据质量很低，关于 CPIP 的证据质量也很低。汇总荟萃分析估计，疝气复发的 OR 为 2.80 (95% CI 0.61–12.77)，CPIP 的视觉模拟量表 (VAS) 平均差异为 0.17 (95% CI 0.90–1.24)。