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. 2013 Sep;1(2):127-37.
doi: 10.1093/gastro/got002. Epub 2013 Apr 5.

Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials

Muhammad S Sajid  1 , L Craciunas, K K Singh, P Sains, M K Baig
Affiliations

Open transinguinal preperitoneal mesh repair of inguinal hernia: a targeted systematic review and meta-analysis of published randomized controlled trials

Muhammad S Sajid et al. Gastroenterol Rep (Oxf). 2013 Sep.

Abstract

Objective: The objective of this article is to systematically analyse the randomized, controlled trials comparing transinguinal preperitoneal (TIPP) and Lichtenstein repair (LR) for inguinal hernia.

Methods: Randomized, controlled trials comparing TIPP vs LR were analysed systematically using RevMan® and combined outcomes were expressed as risk ratio (RR) and standardized mean difference.

Results: Twelve randomized trials evaluating 1437 patients were retrieved from the electronic databases. There were 714 patients in the TIPP repair group and 723 patients in the LR group. There was significant heterogeneity among trials (P < 0.0001). Therefore, in the random effects model, TIPP repair was associated with a reduced risk of developing chronic groin pain (RR, 0.48; 95% CI, 0.26, 0.89; z = 2.33; P < 0.02) without influencing the incidence of inguinal hernia recurrence (RR, 0.18; 95% CI, 0.36, 1.83; z = 0.51; P = 0.61). Risk of developing postoperative complications and moderate-to-severe postoperative pain was similar following TIPP repair and LR. In addition, duration of operation was statistically similar in both groups.

Conclusion: TIPP repair for inguinal hernia is associated with lower risk of developing chronic groin pain. It is comparable with LR in terms of risk of hernia recurrence, postoperative complications, duration of operation and intensity of postoperative pain.

Keywords: Lichtenstein repair; chronic groin pain; inguinal hernia; transinguinal preperitoneal mesh repair.

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Figures

Figure 1
Figure 1
PRISMA flow chart showing trial selection methodology.
Figure 2
Figure 2
Strength and summary of the evidence analysed on GradePro®.
Figure 3
Figure 3
Forest plot for chronic groin pain following TIPP repair vs LR. Risk ratios are shown with 95 per cent confidence intervals. TIPP = transinguinal preperitoneal, LR = Lichtenstein repair.
Figure 4
Figure 4
Forest plot for recurrence following TIPP repair vs LR. Risk ratios are shown with 95 per cent confidence intervals. TIPP = transinguinal preperitoneal, LR = Lichtenstein repair.
Figure 5
Figure 5
Forest plot for postoperative complications following TIPP repair vs LR. Risk ratios are shown with 95 per cent confidence intervals. TIPP = transinguinal preperitoneal, LR = Lichtenstein repair.
Figure 6
Figure 6
Forest plot for postoperative incidence of moderate to severe pain following TIPP repair vs LR. Risk ratios are shown with 95 per cent confidence intervals. TIPP = transinguinal preperitoneal, LR = Lichtenstein repair.
Figure 7
Figure 7
Forest plot for postoperative pain intensity following TIPP repair vs LR. Standardized mean difference (SMD) is shown with 95 per cent confidence intervals. TIPP = transinguinal preperitoneal, LR = Lichtenstein repair.
Figure 8
Figure 8
Forest plot for duration of operation following TIPP repair vs LR. Standardized mean difference (SMD) is shown with 95 per cent confidence intervals. TIPP = transinguinal preperitoneal, LR = Lichtenstein repair.
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