Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand.
Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand.
Surgeon. 2019 Aug;17(4):215-224. doi: 10.1016/j.surge.2018.09.002. Epub 2018 Oct 27.
Laparoscopic totally extra-peritoneal inguinal hernia repair is the standard option for inguinal hernia treatment. However, there are various types of mesh fixation and their relative uses are still controversial. This network meta-analysis was conducted to compare and rank the different fixations available for TEP. Medline and Scopus databases were search until February 1, 2017 and using randomized controlled trials comparing outcomes between different mesh fixation techniques were included. The results demonstrated that fifteen RCTs (n = 1783) were eligible for pooling. Five types of mesh fixation were used; metallic tack, no-fixation, absorbable tack, suture, and glue. Network meta-analysis that use metallic tack as the reference, indicated that suture and glue both carried a lower risk of recurrence with pooled risk ratios (RR) of 0.29 (95% CI 0.00, 18.81) and 0.29 (0.07, 1.30), respectively. For overall complications, absorbable tack had lower risk (0.63, 95% CI: 0.02, 16.13). However, none of these estimates reached statistical significance. So, this network meta-analysis suggests that glue and absorbable tack might be best in lowering recurrence risk and complications. However, a large scale RCT is still needed to confirm these results.
腹腔镜完全腹膜外腹股沟疝修补术是腹股沟疝治疗的标准选择。然而，有各种类型的网片固定方法，其相对用途仍存在争议。本网络荟萃分析旨在比较和排列 TEP 可用的不同固定方法。检索了 Medline 和 Scopus 数据库，直到 2017 年 2 月 1 日，并纳入了比较不同网片固定技术之间结局的随机对照试验。结果表明，有十五项 RCT（n=1783）符合纳入标准。使用了五种类型的网片固定：金属钉、无固定、可吸收钉、缝线和胶水。以金属钉作为参照的网络荟萃分析表明，缝线和胶水固定复发风险均较低，汇总风险比（RR）分别为 0.29（95%可信区间 0.00，18.81）和 0.29（0.07，1.30）。对于总体并发症，可吸收钉的风险较低（0.63，95%可信区间：0.02，16.13）。然而，这些估计均未达到统计学意义。因此，本网络荟萃分析表明，胶水和可吸收钉可能在降低复发风险和并发症方面具有优势。然而，仍需要进行大规模 RCT 来证实这些结果。
