Meta-analysis of postoperative pain using non-sutured or sutured single-layer open mesh repair for inguinal hernia

Abstract

Background: Chronic postoperative pain occurs in up to 21·7 per cent of patients undergoing open inguinal hernia repair. Several mesh fixation techniques using glue or self-gripping meshes have been developed to reduce postoperative pain. The aim of this meta-analysis was to evaluate RCTs comparing adhesional/self-gripping and sutured single-layer open mesh fixations in the repair of inguinal herniation, with postoperative pain as endpoint.

Methods: PubMed, Embase and Cochrane CENTRAL databases were searched systematically for RCTs according to the PRISMA guidelines; the study was registered at PROSPERO (CRD42017056373). Different fixation methods were analysed. The primary outcome, chronic pain, was defined as a postoperative visual analogue scale (VAS) score of at least 3 at 12 months. Secondary outcomes were mean VAS score at 1 week and at 1 month after surgery.

Results: Twenty-three studies including 5190 patients were included in the meta-analysis. Adhesional (self-adhering or glued) or self-gripping fixation methods were associated with a significantly lower VAS score at 1 week (mean difference -0·49, 95 per cent c.i. -0·81 to -0·17; P = 0·003) and at 1 month (mean difference -0·31, -0·58 to -0·04; P = 0·02) after surgery than suture fixation, but the incidence of chronic pain after 12 months was similar in the two groups (odds ratio 0·70, 95 per cent c.i. 0·30 to 1·66). Differences in recurrences and complications between groups did not reach statistical significance.

Conclusion: There was no difference in the incidence of chronic pain 12 months after different mesh repair fixation techniques despite significant reductions in short-term postoperative pain favouring a non-sutured technique. There were no differences in recurrence rates or in rates of other complications at 1 year.

Figure 1

PRISMA diagram showing selection of articles for review

Figure 2

Summary of risk of bias across included studies

Figure 3

Funnel plot for primary outcome

Figure 4

Forest plot comparing postoperative pain after hernia repair with adhesional or self‐gripping fixation versus suture fixation. a Pain scores after 1 week, b pain scores after 1 month and c incidence of pain after 12 months. Mean differences and odds ratios are shown with 95 per cent confidence intervals. An inverse‐variance (a,b) or Mantel–Haenszel (c) random‐effects model was used for meta‐analysis. *Values are mean(s.d.)

Figure 5

Forest plot comparing rates of recurrence, haematoma, seroma and surgical‐site infection after hernia repair with adhesional or self‐gripping fixation versus suture fixation. Rates of a recurrence, b haematoma, c seroma and d surgical‐site infection. Odds ratios are shown with 95 per cent confidence intervals. A Mantel–Haenszel random‐effects model was used for meta‐analysis

Figure 6

Forest plot comparing procedure times after hernia repair with adhesional or self‐gripping fixation versus suture fixation. Mean differences are shown with 95 per cent confidence intervals. An inverse‐variance random‐effects model was used for meta‐analysis. *Values are mean(s.d.)