Nehemiah Samuel, Mr, Maria Tsachiridi, Miss, Ajay Gupta, Fayyaz Mazari, Mr, Antonio Durham-Hall, Miss, Srinivasan Balachandra, Mr. Doncaster Royal Infirmary
Background: In Laparoscopic Inguinal Hernia (LIH) surgery, the type of mesh and its fixation techniques have been long debated in context to post-operative pain, recurrence, shrinkage, and migration. The relatively new Self-gripping mesh is intended to address these shortcomings and has been shown to shorten duration of operation, with studies declaring non-inferiority in perioperative complications, chronic groin pain and recurrence rates (in open hernia repairs); also lowering the cost of the procedure by combining the functionality of mesh and fixation into one device (in laparoscopic repairs).
Aim: This study was designed to systematically analyse all published RCTs comparing early and long term outcomes of self-gripping mesh and ‘lightweight’ polypropylene mesh often fixed with a fixation device in the laparoscopic repair of moderate to large sized inguinal hernia defects.
Methods: A literature search was performed using the Cochrane Colorectal Cancer Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase and Science Citation Index Expanded. RCTs comparing self-gripping mesh with standard polypropylene mesh was included.
The primary outcome measures were chronic pain after operation and hernia recurrence. Secondary outcome measures were technical success, operative time, analgesia requirement, perioperative complications, return to work, quality of life improvement and cost effectiveness of the two techniques.
Results: From all the studies reported in literature on the treatment of inguinal hernias and the newer self-gripping mesh, unfortunately not a single RCT was identified that compared the self-gripping mesh with the standard mesh in the laparoscopic repair of inguinal hernias. Hence meaningful outcome measures could not be compiled from the published studies which were predominantly retrospective case-series.
Conclusion: With the introduction of the newer self-fixating mesh (functionality of mesh and fixation combined in the same device) the hypothesis that it offers advantages of less post-operative pain and increased effectiveness of repair even in moderate to large sized hernia defects is well worth pursuing in an RCT setting. In the era of laparoscopic ‘key-hole’ surgery, evidence that a particular technique improves patient based surgical outcome measures will have a significant impact on future clinical practice.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87666
Program Number: P031
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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