Glue versus tackers for mesh fixation in laparoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis

Abstract

Purpose: Mesh fixation in laparoscopic inguinal hernia repair has improved patient outcomes compared to natural tissue repair. The method of fixation of the mesh to the abdominal wall and its impact on patient outcomes has not been determined as part of a trial sequential analysis. The aim of this study is to compare the use of glue and tackers in mesh fixation of inguinal and femoral hernia repair by meta-analysis and trial sequential analysis (TSA).

Method: Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched to retrieve relevant randomised controlled trials (RCT) comparing glue and tacker fixation in laparoscopic inguinal and femoral hernia repair, resulting in 648 studies, of which 18 met the inclusion criteria. This data was systematically analysed using RevMan and TSA software.

Results: 2312 patients were included in the 18 RCTs used in this study, with 1149 in the glue cohort and 1163 in the tacker cohort. Glue fixation significantly reduced risk of haematoma formation [MD (95% CI): 0.35 (0.17-0.73), P < 0.01]. Glue fixation resulted in significantly less acute pain [MD (95% CI): - 1.80 (- 2.71 to - 0.89), P < 0.01] and chronic pain [MD (95% CI): 0.42 (0.27-0.64), P < 0.01]. Glue fixation also allowed significantly quicker return to normal activity/work compared to tacker fixation [MD (95% CI): - 1.92 (- 3.17 to - 0.67), P < 0.01]. TSA confirmed that glue fixation significantly reduced early pain scores (< 3 months) and haematoma incidence compared to tacker fixation.

Conclusion: Mesh fixation with glue is superior to tackers in reducing post-operative pain and haematomas, which means patients return to work/activity significantly faster. Surgeons should be aware of these benefits when consenting the patient for laparoscopic inguinal and femoral hernia repair.

Keywords: Fibrin; Glue; Hernia; Laparoscopic; Mesh; Tackers.

Fig. 1

PRISMA flowchart

Fig. 2

Risk of bias assessment

Fig. 3

Forest plot of operative time (a), haematoma (b), VAS pain after < 3 months (c), recurrence (d), return to work/activity (e) and seroma (f)

Fig. 4

Forest plot of surgical site infection (a), VAS pain after > 3 months (b), chronic pain (c), stay in hospital (d)

Fig. 5

Trial sequential analysis of operative time (a), haematoma (b), VAS pain after < 3 months (c), recurrence (d)

Fig. 6

Trial sequential analysis of chronic pain (a) and hospital stay (b)

Fig. 7

Trial sequential analysis of return to work/activity (a), seroma (b), surgical site infection (c), VAS pain > 3 months (d)