Riemenschneider K A, Lund H, Pommergaard H C
Department of Surgery and Transplantation, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
Department of Surgery, Nordsjaellands Hospital, Dyrehavevej 29, 3400, Hilleroed, Denmark.
Surg Endosc. 2023 Nov;37(11):8291-8300. doi: 10.1007/s00464-023-10237-0. Epub 2023 Sep 6.
To investigate the differences in hernia recurrence and chronic postoperative inguinal pain (CPIP) in randomized, controlled trials comparing fixation and non-fixation of the mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.
A multi-database systematic search was conducted for randomized, controlled trials comparing fixation versus non-fixation of the mesh in TAPP inguinal hernia repair. All eligible papers were assessed for risk of bias using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Quality of evidence was evaluated using the GRADE system. Meta-analyses were performed regarding recurrence and CPIP using RevMan.
Seven prospective, randomized controlled trials were included. Laparoscopic TAPP inguinal hernia repair was performed in 1732 patients with 737 procedures performed without fixation and 995 procedures with fixation of the mesh. Despite all trials being RCTs, the trials were limited by substantial bias and the quality of evidence was low regarding hernia recurrence and very low regarding CPIP. Pooled estimates from meta-analyses were an OR of 2.80 (95% CI 0.61-12.77) for hernia recurrence and a mean difference in visual analogue scale (VAS) of 0.17 (95% CI 0.90-1.24) for CPIP, respectively.
The current evidence is very uncertain and mesh fixation may have little to no effect regarding hernia recurrence and chronic postoperative inguinal pain in patients operated with TAPP inguinal hernia repair.
在比较腹腔镜经腹腹膜前（TAPP）腹股沟疝修补术中补片固定与不固定的随机对照试验中，研究疝复发和慢性术后腹股沟疼痛（CPIP）的差异。
对比较TAPP腹股沟疝修补术中补片固定与不固定的随机对照试验进行多数据库系统检索。使用修订后的Cochrane随机试验偏倚风险工具（RoB 2.0）对所有符合条件的论文进行偏倚风险评估。采用GRADE系统评估证据质量。使用RevMan对复发率和CPIP进行荟萃分析。
纳入7项前瞻性随机对照试验。1732例患者接受了腹腔镜TAPP腹股沟疝修补术，其中737例手术未进行补片固定，995例手术进行了补片固定。尽管所有试验均为随机对照试验，但这些试验存在大量偏倚，关于疝复发的证据质量低，关于CPIP的证据质量极低。荟萃分析的合并估计值显示，疝复发的比值比（OR）为2.80（95%可信区间0.61 - 12.77），CPIP的视觉模拟量表（VAS）平均差为0.17（95%可信区间0.90 - 1.24）。
目前的证据非常不确定，在接受TAPP腹股沟疝修补术的患者中，补片固定对疝复发和慢性术后腹股沟疼痛可能几乎没有影响。
