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The following is a summary of “Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis,” published in the October 2024 issue of Surgery by Jiang et al.
Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a standard surgical procedure where mesh is used to reinforce the abdominal wall. The fixation of mesh has been debated concerning safety and effectiveness.
Researchers conducted a prospective study comparing the clinical efficacy of mesh non-fixation and fixation in laparoscopic TAPP inguinal hernia repair.
They searched PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases to identify RCTs comparing mesh non-fixation and fixation in laparoscopic TAPP inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence grading system was employed for outcome quality assessment. Publication bias analysis was performed using Begg’s test. A trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software.
The results showed that compared to the fixation group, the non-fixation group had a significantly lower seroma occurrence rate [RR = 0.43, 95% CI (0.20, 0.89), P=0.02, heterogeneity P=0.28, I2 =22%], a lower Visual Analog Scale (VAS) pain score at 6 months postoperatively [MD=-0.21, 95% CI (-0.29, -0.12), P<0.00001, heterogeneity P=0.34, I2 =0%], and reduced cost [MD=-3.23 thousand yuan, 95% CI (-4.26, -2.19), P<0.00001, heterogeneity P=0.0003, I2 =92%]. No significant differences in overall complication rate [RR = 0.88, 95% CI (0.62, 1.23), P=0.45, heterogeneity P=0.11, I2 =44%], overall infection event rate [RR = 0.96, 95% CI (0.36, 2.56), P=0.93, heterogeneity P=0.62, I2 =0%], or recurrence rate [RR = 0.75, 95% CI (0.28, 1.99), P=0.56, heterogeneity P=0.44, I2 =0%].
They concluded that mesh non-fixation in laparoscopic TAPP inguinal hernia repair was safe and did not increase the risk of hernia recurrence. However, further multicenter, high-quality RCTs are needed for validation.
Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02628-4
