Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair

doi:10.1016/j.amjsurg.2015.06.008

The American Journal of Surgery

Volume 211, Issue 1, January 2016, Pages 239-249.e2

https://doi.org/10.1016/j.amjsurg.2015.06.008 Get rights and content

Highlights

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Bioglue has recently emerged as an alternative means of mesh fixation in open and laparoscopic groin hernia repair.
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Synthesis of data suggests that this method reduces chronic postoperative pain, without increasing morbidity or recurrence.
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Longer term data on recurrence are needed.

Abstract

Background

Evidence for open groin hernia repair demonstrates less pain with bioglue mesh fixation compared with invasive methods. This study aimed to assess the short- and long-term effects of laparoscopic groin hernia repair with noninvasive and invasive mesh fixation.

Data Sources

A systematic review of MEDLINE, CENTRAL, and OpenGrey was undertaken. Randomized trials assessing the outcome of laparoscopic groin hernia repair with invasive and noninvasive fixation methods were considered for data synthesis. Nine trials encompassing 1,454 patients subjected to laparoscopic hernia repair with mesh fixation using biologic or biosynthetic glue were identified. Short-term data were inadequate for data synthesis. Chronic pain was less frequently reported by patients subjected to repair with biologic glue fixation than with penetrating methods (odds ratio .46, 95% confidence interval .22 to .93). Duration of surgery, incidence of seroma/hematoma, morbidity, and recurrence were similar.

Conclusions

Laparoscopic groin hernia repair with bioglue mesh fixation was associated with a reduced incidence of chronic pain compared with mechanical fixation, without increasing morbidity or recurrence. Longer term data on recurrence are necessary.

Section snippets

Protocol

A protocol was built by the primary authors, which was subjected to modification after proposal and consensus of the author team. The final protocol was registered and is fully accessible from the International Prospective Register of Systematic Reviews (registration no. CRD42014015374), a database built and maintained by the Centre for Reviews and Dissemination of the University of York, UK.²² The protocol conformed to the Preferred Reporting Items in Systematic reviews and Meta-Analyses

Selection of studies

A total of 298 records were identified in the MEDLINE, CENTRAL, and OpenGrey databases. First-level screening excluded 260 records and 25 unique records were selected for full-text review. Nine trials fulfilled the predetermined inclusion criteria and were included in the meta-analysis.27, 28, 29, 30, 31, 32, 33, 34, 35 The search and selection process are outlined in Fig. 1. A list of excluded reports is available on request.

Study characteristics

No randomized trials reported on the use of self-adhering meshes or a

Comments

An increased likelihood for postoperative pain beyond 3 months after laparoscopic inguinal hernia repair with penetrating mesh fixation is supported by the present analysis, with similar perioperative morbidity, duration of surgery, and risk for recurrence when compared with bioglue fixation. There were only 4 available trials providing relevant data, which limits the confidence on this outcome estimate. However, consistent results with no evidence of heterogeneity were demonstrated. Available

Conclusions

In view of the results of the present analysis and the features of the included reports, the use of bioglues may be supported as an alternative approach to mechanical fixation in laparoscopic groin hernia repair without an increase in operative morbidity. Routine application cannot be supported until long-term results are available. Adequate reporting of short-term and long-term results in future research within the context of established surgical principles is essential.

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In vivo comparison of mesh fixation solutions in open and laparoscopic procedures for inguinal hernia repair: A meta-analysis
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Abdominal hernia repair surgeries involve the fixation of a surgical mesh to the abdominal wall with different means such as suture, tacks, and glues. Currently, the most effective mesh fixation system is still debated. This review compares outcomes of mesh fixation in different surgical procedures, aiding surgeons in identifying the optimal technique.
A meta-analysis was conducted according to PRISMA guidelines. Articles published between January 2003 and January 2023 were searched in electronic databases. Randomized controlled trials (RCTs) comparing mesh fixation with cyanoacrylate-based or fibrin glues with classical fixation techniques (sutures, tacks) in open and laparoscopic procedures were included.
17 RCTs were identified; the cumulative study population included 3919 patients and a total of 3976 inguinal hernias. Cyanoacrylate-based and fibrin glues were used in 1639 different defects, suture and tacks in 1912 defects, self-gripping mesh in 404 cases, and no mesh fixation in 21 defects. Glue fixation resulted in lower early postoperative pain, and chronic pain occurred less frequently. The incidence of hematoma was lower with glue fixation than with mechanical fixation. Recurrence rate, seroma formation, operative and hospitalization time showed no significant differences; but significantly, a higher number of people in the glue group returned to work by 15- and 30-days after surgery when compared to the tacker and suture groups in the same time frame.
Cyanoacrylate and fibrin glue may be effective in reducing early and chronic pain and hematoma incidence without increasing the recurrence rate, the seroma formation, or the operative and hospitalization time.
Efficacy and safety of glue mesh fixation for laparoscopic inguinal hernia: A meta-analysis of randomized controlled trials
2023, Asian Journal of Surgery
It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P < 0.00001], urinary retention[RR = 0.53, 95% CI(0.29,0.97), P = 0.04], haematoma[RR = 0.23, 95% CI(0.09,0.58), P = 0.002] and total complications[RR = 0.28, 95% CI(0.18,0.44), P < 0.00001]; there were no significant differences in pain score on postoperative day 1[MD = −1.33, 95% CI(-2.93,0.26), P = 0.10], operation time[MD = 1.46, 95% CI(-3.97,6.88), P = 0.60] and recurrence rate[RR = 0.72, 95% CI(0.35,1.47), P = 0.37] between the two groups. In conclusion, the application of glue mesh fixation in laparoscopic inguinal hernia repair is safe and reliable with fewer complications. Moreover, it can reduce the incidence of chronic pain without increasing the recurrence rate. However, due to the small number of cases in this analysis and limitations in the quality of the included studies, the findings need to be further verified by multicentre, large-sample and high-quality RCTs in the future.
Chronic postoperative inguinal pain: A narrative review
2021, Cirugia Espanola
El dolor inguinal crónico posquirúrgico constituye una complicación de incidencia variable entre los pacientes intervenidos de hernia inguinal. La tendencia actual de medición de resultados en términos de calidad de vida (patient reported outcome measurment) ha puesto de manifiesto la importancia de esta complicación, debido a las limitaciones de actividad diaria e implicaciones socioeconómicas que genera. En este artículo se realiza una revisión narrativa de la literatura disponible en las plataformas PUBMED, EMBASE y Cochrane Library y se discuten los principales aspectos concernientes a la epidemiología, etiología, prevención, diagnóstico y tratamiento del dolor inguinal crónico posquirúrgico, proponiéndose un algoritmo para su manejo. Los pacientes que padecen dolor inguinal crónico posquirúrgico presentan un amplio espectro de manifestaciones clínicas y su diagnóstico supone un auténtico desafío. No existe un tratamiento estándar y el éxito del mismo radica en un adecuado diagnóstico etiológico para poner a disposición del paciente el amplio abanico de medidas terapéuticas de las que se dispone de forma individualizada.
Inguinodynia or chronic postoperative inguinal pain is a growing problem between patients who undergo surgical repair of an inguinal hernia. The change in results measurement proposed by many authors towards Patient Reported Outcome Measurement has underlined the importance of chronic postoperative inguinal pain, because of the great limitations in everyday life and the huge socioeconomic impact that it causes. In this article a narrative review of the available literature in PUBMED, EMBASE and Cochrane Library is performed and the most relevant aspects about epidemiology, etiology prevention, diagnosis and treatment of chronic postoperative inguinal pain are discussed. A new management algorithm is also proposed. The variability in its incidence and clinical presentation makes diagnosis of chronic postoperative inguinal pain a very challenging issue. There is no standardized therapy and an adequate etiological diagnosis is key point for a successful treatment. There are many treatment options that have to be sequentially used and adjusted to each patient and their clinical features.
Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: Short and long term outcome. Randomized controlled clinical trial
2020, International Journal of Surgery
Citation Excerpt :
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 OHR [4–11] (i.e., glue vs. suture (n = 5) [4,5,7,8,10] and self-gripping mesh vs. suture (n = 3) [6,9,11] and one network meta-analysis (NMA) [12] For LHR, comparisons were tack and glue (n = 6) [9,13–17]. Fixation versus no fixation (n = 3) [9,18,19].
Inguinal hernioplasty is the standard treatment for inguinal hernia in adults. Mesh fixation was used to keep mesh in place for which various mesh fixation techniques have been used in laparoscopic inguinal hernia repair in adults, but their effectiveness has remained inconclusive.
to evaluate non fixation method of mesh laparoscopic inguinal hernioplasty as safe and effective as regard short and long term outcomes.
Over the period from July 2013 to July 2018, 798 patients with oblique inguinal hernias undergoing Trans abdominal preperitoneal technique (TAPP) were randomized into 3 groups: Group A; mesh non fixation 266 patients. Group B; tacker mesh fixation 266 patients Group C: Cyanoacrylic tissue glues (Histoacryl) mesh fixation 266 patients. Clinical effects were assessed by the following variables: intraoperative data, postoperative outcome as regard recurrence rate, postoperative pain [on visual analogue score (VAS)], analgesic consumption, operation time, hospital stay, and patient costs. Follow up was 18 months.
There was no statistical difference between groups (A) and Group (C) regarding operative time, postoperative complications, and length of hospital stay and risk of chronic groin pain, postoperative pain score. In Group (B): the postoperative pain and complications were higher. There were 5 cases of hernia recurrence in all groups, but no significant differences among the three groups.
Tacker Mesh fixation increased the risk of chronic groin pain. Pain score was higher with tacker mesh fixation. Laparoscopic TAPP inguinal hernia repair without tacker mesh fixation was safe and feasible with no significant increase in recurrence rates. Furthermore, mesh fixation with tacker procedure increased the risk of postoperative complications and patient costs.
All ethical approval was given by our Faculty of Medicine medical ethical committee.
Cyanoacrylate mesh fixation for laparoscopic inguinal hernia repair: a prospective, multicenter, single-arm study
2023, Surgical Endoscopy
Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP)
2023, BMC Surgery

View all citing articles on Scopus

: There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

: The authors declare no conflicts of interest.

View full text

ReviewMeta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair

Highlights

Abstract

Background

Data Sources

Conclusions

Section snippets

Protocol

Selection of studies

Study characteristics

Comments

Conclusions

Surg Clin North Am

Exp Cell Res

Gastrointest Endosc

J Gastrointest Surg

Eur J Surg Oncol

J Clin Epidemiol

Control Clin Trials

Surgery

Am J Surg

Pain

J Surg Res

Prevalence of treated and untreated groin hernia in eastern Uganda

Br J Surg

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Hernia

Operation compared with watchful waiting in elderly male inguinal hernia patients: a review and data analysis

J Am Coll Surg

Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society)

Surg Endosc

Current treatment concepts for groin hernia

Langenbecks Arch Surg

Inguinodynia following Lichtenstein tension-free hernia repair: a review

World J Gastroenterol

Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis

Surg Endosc

A review of chronic pain after inguinal herniorrhaphy

Clin J Pain

Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGripTM mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months

Hernia

Use of fibrin sealants in cardiovascular surgery: a systematic review

J Card Surg

Fibrin sealant (evicel® [quixil®/crossealTM]): a review of its use as supportive treatment for haemostasis in surgery

Drugs

Current state and use of biological adhesives in orthopedic surgery

Orthopedics

Wound coverage technologies in burn care: novel techniques

J Burn Care Res

Review
Meta-analysis of randomized trials comparing nonpenetrating vs mechanical mesh fixation in laparoscopic inguinal hernia repair

Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGrip^TM mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months

Fibrin sealant (evicel® [quixil®/crosseal^TM]): a review of its use as supportive treatment for haemostasis in surgery