Efficacy and safety of mesh non-fixation in patients undergoing laparo-endoscopic repair of groin hernia: a systematic review and meta-analysis

Abstract

Purpose: To examine updated evidence on the efficacy and safety of mesh non-fixation in patients undergoing laparo-endoscopic repair of groin hernias. Methods: We searched MEDLINE, Cochrane Central Library, Embase, ClinicalTrials. gov, and ICTRP databases to identify randomized controlled trials. The primary outcomes were recurrence, chronic pain, and return to daily life. The certainty of evidence (CoE) was assessed by grading recommendations, assessments, developments, and evaluations. We performed a subgroup analysis based on the surgical type. This study was registered with PROSPERO (CRD 42022368929). Results: We included 25 trials with 3,668 patients (4,038 hernias) were included. Mesh non-fixation resulted in little to no difference in hernia recurrence (relative risk [RR]:1.40, 95% confidence interval [CI]:0.59–3.31; I2 = 0%; moderate CoE) and chronic pain (RR:0.48, 95% CI:0.13–1.78; I2 = 77%; moderate CoE), but reduced return to daily life (mean difference [MD]: − 1.79 days, 95% CI: − 2.79 to –0.80; I2 = 96%; low CoE). In subgroup analyses, the transabdominal preperitoneal approach (TAPP) (MD: − 2.97 days, 95% CI: − 4.87 to − 1.08; I2 = 97%) reduced return to daily life than total extraperitoneal inguinal approach (MD: − 0.24 days, 95% CI − 0.71 to 0.24; I2 = 61%) (p = 0.006). Conclusions: Mesh nonfixation improves the return to daily life without increasing the risk of hernia recurrence or chronic pain. Surgeons and patients may discuss mesh nonfixation options to accommodate a patient’s desired return to daily life. Further trials focusing on TAPP are required to confirm these findings.