A Meta-analysis Of Mesh Fixation Versus Nonfixation In Laparoscopic Inguinal Hernia Repair

Objective The laparoscopic inguinal hernia repair is widely promoted and applied for its advantages of less postoperative pain, minimal trauma and quicker recovery,one controversial issue-whether the mesh should be fixed-is still debatable. The aim of the present study was to systematically analyze the effectiveness of mesh fixation versus nonfixation in laparoscopic inguinal hernia repair.Methods Randomized controlled trials(RCTs) comparing mesh fixation versus nonfixation in laparoscopic inguinal hernia repair were identified from Pub Med,Medline,EMBASE, SCI and CBMdisk. All the related data that matched our standards were subjected to meta-analysis by Cochrane Handbook 5.0 software and combined outcomes were expressed as Relative risk(RR) and mean difference(MD).Results A total of eight RCTs assessing 1386 participants(mesh nonfixation 686 cases, mesh fixation 700 cases) were finally included.Meta-analysis showed that there were no significant differences on recurrence rate( RR=2.07, 95%CI 0.39~11.06, p=0.1598),chronic postoperative pain(RR=1.47, 95%CI 0.45~4.86,p=0.7918),seroma(RR=1.15, 95%CI 0.61~2.19, p=0.6177)and time to return to normal activities(MD= 0.00, 95%CI-0.22~0.23, p=0.3058. The mesh fixation group needed more operative time(MD=-1.94, 95%CI-2.98~-0.90, P=0.5151) and longer length of hospital stay(MD=-6.21,95%CI-12.17~-0.24,P=0.0015).Conclusion The mesh fixation group needed more operative time and longer length of hospital stay. Conclusion: There is no noticeable difference in the clinical effectiveness between the mesh fixation and nonfixation in laparoscopic inguinal hernia repair,the mesh fixation group costs more operative and longer hospital stay.