Department of General Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK.
Imperial College School of Medicine, Imperial College London, London, UK.
Br J Surg. 2021 Jan 27;108(1):14-23. doi: 10.1093/bjs/znaa002.
The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications.
A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model.
Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88).
Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.
腹腔镜腹股沟疝修补术（LIHR）中，尚未明确网片固定的最佳选择。本综述比较了 LIHR 中胶水与机械网片固定在慢性术后腹股沟疼痛（CPIP）及其他次要结局（包括急性疼痛、血清肿、血肿、疝复发和其他术后并发症）方面的效果。
通过检索 MEDLINE、Cochrane 图书馆、OpenGrey、OpenThesis 和 Web of Science 中的英文/非英文研究，并查阅纳入研究的参考文献，完成了系统综述。检索词包括腹腔镜、疝、纤维蛋白胶、Tisseel、Tissucol、氰基丙烯酸酯、Glubran 和 Liquiband。仅纳入了比较成人（年龄>18 岁）患者中机械固定与胶基固定的 RCT 研究，这些研究检查了 CPIP。两位作者独立地根据预定义的数据字段进行了偏倚风险评估和数据提取。所有汇总分析均采用随机效应模型进行计算。
15 项 RCT 符合纳入标准，2109 例患者中的 2777 例疝接受了评估。与机械固定相比，使用胶基固定可降低 CPIP 的发生率（风险比（RR）0.36，95%置信区间 0.19 至 0.69；P=0.002），存在中度异质性，但敏感性分析（8 个自由度）去除患者盲法研究后消失（RR 0.43，0.27 至 0.86）。试验序贯分析提供了至少 25%的相对风险降低证据。与机械固定相比，使用胶基固定可降低血肿的发生率（RR 0.29，0.10 至 0.82；P=0.02），对血清肿形成或疝复发无显著影响（RR 1.07，0.46 至 2.47；P=0.88）。
与机械固定相比，LIHR 中胶基网片固定似乎可降低 CPIP 和血肿的发生率，而复发率相当。
