The Incidence Rates Of Seroma Followed By Three Kinds Of Tension-Free Hernia Repair:a Network Meta-Analysis

ObjectivesTo evaluate the seroma morbidity of totally extraperitoneal hernia repair(TEP),transabdominal preperitoneal hernia repair(TAPP)and Lichtenstein tension-free herniorrhaphy by network meta-analysis and provide the evidence-based proof for the choice of surgical methods.MethodDatabases of PubMed,Web of Science,EBSCO,CNKI,Wan Fang and VIP were searched for the literatures concerning seroma incidence rate and inguinal tension-free herniorrhaphy.The final retrieval date was March 11,2019.Articles were selected according to the given inclusion criteria,and then,the quality of the included studies was evaluated through the Jadad scale table.Network Meta-analysis was performed by GeMTC14.3 and Stata 20.0 software.ResultA total of 60 articles were included,with 34,932 patients in total.After examination,no significant heterogeneity was found among the included independent studies,and the quality scores of evidence were all above 4 points.Indirect comparison method was used to assess the seroma incidence rates for those three kinds of surgery.According to the probability ranking and the surface under the cumulative ranking curve(SUCRA),the probability ranking of postoperative seroma from high to low are Lichtenstein,TAPP and TEP.The seroma morbidity in Lichtenstein is significantly higher than that in TEP [RR=1.56,95%CI(1.04,2.40)],which with statistical significance.ConclusionBased on the results of network meta-analysis,the occurrence rate of seroma after TEP is significantly lower than the other methods,which is worthily popularizing.