Laparoscopic Totally Extraperitoneal Hernia Repair With Or Without Mesh Fixation:A Meta-analysis

Objective:The objective of this article is systematically analyse the effectiveness in laparoscopic total extraperitoneal hernia repair(TEP)with or without mesh fixation.Methods:We searched databases as PUBMED、Cochrane library、EMBASE、Web of Science、CNKI、Wan Fang and VIP with the words of “inguinal hernia*”、“groin hernia*”、“laparoscopic*”、“fix*OR stapl*”、“unfix*OR nofix*”、“unstapl*OR nonstapl*” to collect the randomized controlled trails(RCTs)and quasi-randomized controlled trails(qRCTs)which were published from January 1994 to March 2018.The language of the literature is limited to: Chinese and English.The search was followed the inclusion and exclusion criteria.The combined risk estimates were computed using either fixed—effects models or random effects models with the presence of heterogeneity.We also investigated the influence of a single study on the overall risk estimate by omitting 1 study in each turn.Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 software.Results:At the beginning,637 related articles were searched,and 11 articles were finally included.All the included articles were randomized controlled trials,and a total of 1067 patients were included in this study.Compared with TEP with mesh fixation,TEP without mesh fixation had no significant difference in time to return normal activity [ SMD=-0.20,95%CI(-0.54,0.13)],risk of hernia recurrence [ OR=0.56,95%CI(0.04,8.39)] and postoperative complications [ OR=1.455,95%CI(0.980,2.161)],but operative time [ SMD=-0.39,95%CI(-0.51,-0.26)],length of hospital stay [ SMD=-0.39,95%CI(-0.51,-0.26)],hospital cost [SMD=-1.424,95%CI(-2.552,-0.297),P=0.013] postoperative pain score[ SMD=-0.178,95%CI(-0.308,-0.049)],chronic groin pain [ OR=2.01,95%CI(1.29,3.13)] was significantly lower.Conclusion:Current evidence suggests that it is comparable with no-fixation in laparoscopic totally extraperitoneal hernia repair in terms of operative time,length of hospital stay,hospital cost,postoperative pain score and chronic groin pain,but no difference in the recent risk of hernia recurrence,time to return normal activity and postoperativecomplications.Thus,laparoscopic totally extraperitoneal hernia repair with no-fixation is worthy of basic clinical application.