Department of General Surgery, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
Department of General Medicine, Zigong Fourth People's Hospital, Zigong, 643000, Sichuan, China.
Asian J Surg. 2023 Sep;46(9):3417-3425. doi: 10.1016/j.asjsur.2023.03.146. Epub 2023 Apr 8.
It is still controversial whether glue can be used for mesh fixation in laparoscopic inguinal hernia repair. The aim of this meta-analysis was used to systematically evaluate the effectiveness and safety of glue mesh fixation in laparoscopic tension-free inguinal hernia repair. The PubMed database, EMBASE database and Cochrane Library were searched to collect published randomized controlled trials (RCTs) on laparoscopic tension-free inguinal hernia repair with glue mesh fixation. Sixteen RCTs and 2409 patients with inguinal hernia were included. The meta-analysis showed that compared with the mechanical mesh fixation group(MMFG), the glue mesh fixation group(GMFG) had significantly reduced incidences of chronic pain[relative risk (RR) = 0.40, 95% confidence interval (CI) (0.28,0.57), P < 0.00001], urinary retention[RR = 0.53, 95% CI(0.29,0.97), P = 0.04], haematoma[RR = 0.23, 95% CI(0.09,0.58), P = 0.002] and total complications[RR = 0.28, 95% CI(0.18,0.44), P < 0.00001]; there were no significant differences in pain score on postoperative day 1[MD = -1.33, 95% CI(-2.93,0.26), P = 0.10], operation time[MD = 1.46, 95% CI(-3.97,6.88), P = 0.60] and recurrence rate[RR = 0.72, 95% CI(0.35,1.47), P = 0.37] between the two groups. In conclusion, the application of glue mesh fixation in laparoscopic inguinal hernia repair is safe and reliable with fewer complications. Moreover, it can reduce the incidence of chronic pain without increasing the recurrence rate. However, due to the small number of cases in this analysis and limitations in the quality of the included studies, the findings need to be further verified by multicentre, large-sample and high-quality RCTs in the future.
在腹腔镜腹股沟疝修补术中使用胶水固定网片是否可行仍存在争议。本荟萃分析旨在系统评价胶水固定网片在腹腔镜无张力腹股沟疝修补术中的有效性和安全性。检索 PubMed 数据库、EMBASE 数据库和 Cochrane 图书馆，收集关于胶水固定网片在腹腔镜无张力腹股沟疝修补术中的已发表随机对照试验（RCT）。纳入 16 项 RCT 和 2409 例腹股沟疝患者。荟萃分析结果显示，与机械网片固定组（MMFG）相比，胶水网片固定组（GMFG）慢性疼痛发生率显著降低[相对风险（RR）=0.40，95%置信区间（CI）（0.28，0.57），P<0.00001]、尿潴留[RR=0.53，95%CI（0.29，0.97），P=0.04]、血肿[RR=0.23，95%CI（0.09，0.58），P=0.002]和总并发症[RR=0.28，95%CI（0.18，0.44），P<0.00001]发生率显著降低；两组术后第 1 天疼痛评分[MD=-1.33，95%CI（-2.93，0.26），P=0.10]、手术时间[MD=1.46，95%CI（-3.97，6.88），P=0.60]和复发率[RR=0.72，95%CI（0.35，1.47），P=0.37]差异均无统计学意义。结论：在腹腔镜腹股沟疝修补术中应用胶水固定网片安全可靠，并发症更少。此外，它可以降低慢性疼痛的发生率，而不会增加复发率。然而，由于本次分析病例数量较少，且纳入研究质量存在局限性，未来需要通过多中心、大样本、高质量 RCT 进一步验证这些发现。
