Efficacy and Safety of Mesh in Laparoscopic Surgery for Groin Hernia: Systematic Review and Meta-Analysis

Xueli Jia, MBBS, PhD, Michelle HsinXuan Ting, MBBS, MSc, Kathleen Irvine, BSc, MCLIP, Angus JM Watson, BSc, MB, ChB, FRCSEd

Department of General Surgery, Ward 4a, Raigmore Hospital, Old Perth Road, Inverness, UK, IV2 3UJ

INTRODUCTION The efficacy and safety of mesh in laparoscopic surgery for groin hernia is uncertain. A systematic review is conducted to compare the efficacy and safety between different types of mesh for totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) groin hernia repair.

METHODS Randomised controlled trials (RCTs) and non-randomised comparative studies published by May 2012 were sought by searching electronic databases including MEDLINE, EMBASE and CLib (CENTRAL), and by scanning reference lists of retrieved papers. Two reviewers independently screened titles/abstracts, undertook data extraction and study quality assessment.

RESULTS Nine studies involving 2281 patients were included of which five were RCTs and four were non-randomised comparative studies. Four RCTs and three non-randomised comparative studies reported TEP and the other two studies reported TAPP. The study quality was generally high. Median follow up was 16 months (range: 2 to 60 months). Partially-absorbable mesh had a higher hernia recurrence rate (2.4%, 25/1028) compared to non-absorbable mesh (1.6%, 18/1137; 4 studies, RR 1.51, 95% CI 0.80–2.84; Figure 1) but had a significantly lower risk of chronic pain after procedure (5 studies, n=1223, RR 0.25, 95% CI 0.12–0.52; Figure 2). There were no significant differences in the rate of hernia recurrence between light-weight non-absorbable mesh (0.9%, 3/328) and heavy-weight non-absorbable mesh (1.9%, 6/319; 4 studies, RR 0.72, 95% CI 0.19–2.80) or in the risk of chronic pain (one study, n=455, RR 0.52, 95% CI 0.05–5.75).

CONCLUSIONS The use of partially-absorbable mesh in laparoscopic hernia repair significantly reduces chronic pain after procedure. Rigorous long-term RCTs are required to determine the comparative efficacy of partially absorbable, light-weight and heavy-weight non-absorbable mesh.

Figure 1: partially absorbable versus non-absorbable mesh – hernia recurrence