Kitching Samuel, Patel Agastya, Tan Jacob, Kadamapuzah Jacob, Satyadas Thomas
Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK.
Regional Hepato-Pancreato-Biliary Surgical Unit, Manchester Royal Infirmary, Manchester, UK.
Hernia. 2025 Apr 5;29(1):134. doi: 10.1007/s10029-025-03315-w.
Mesh fixation in laparoscopic inguinal hernia repair has improved patient outcomes compared to natural tissue repair. The method of fixation of the mesh to the abdominal wall and its impact on patient outcomes has not been determined as part of a trial sequential analysis. The aim of this study is to compare the use of glue and tackers in mesh fixation of inguinal and femoral hernia repair by meta-analysis and trial sequential analysis (TSA).
Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched to retrieve relevant randomised controlled trials (RCT) comparing glue and tacker fixation in laparoscopic inguinal and femoral hernia repair, resulting in 648 studies, of which 18 met the inclusion criteria. This data was systematically analysed using RevMan and TSA software.
2312 patients were included in the 18 RCTs used in this study, with 1149 in the glue cohort and 1163 in the tacker cohort. Glue fixation significantly reduced risk of haematoma formation [MD (95% CI): 0.35 (0.17-0.73), P < 0.01]. Glue fixation resulted in significantly less acute pain [MD (95% CI): - 1.80 (- 2.71 to - 0.89), P < 0.01] and chronic pain [MD (95% CI): 0.42 (0.27-0.64), P < 0.01]. Glue fixation also allowed significantly quicker return to normal activity/work compared to tacker fixation [MD (95% CI): - 1.92 (- 3.17 to - 0.67), P < 0.01]. TSA confirmed that glue fixation significantly reduced early pain scores (< 3 months) and haematoma incidence compared to tacker fixation.
Mesh fixation with glue is superior to tackers in reducing post-operative pain and haematomas, which means patients return to work/activity significantly faster. Surgeons should be aware of these benefits when consenting the patient for laparoscopic inguinal and femoral hernia repair.
与自然组织修复相比，腹腔镜腹股沟疝修补术中的补片固定改善了患者的治疗效果。作为序贯分析试验的一部分，补片与腹壁的固定方法及其对患者治疗效果的影响尚未确定。本研究的目的是通过荟萃分析和序贯分析（TSA）比较胶水和钉合器在腹股沟疝和股疝修补术中补片固定的应用情况。
检索Medline、Cochrane图书馆、Scopus、科学网和EMBASE，以检索比较胶水和钉合器固定在腹腔镜腹股沟疝和股疝修补术中应用情况的相关随机对照试验（RCT），共检索到648项研究，其中18项符合纳入标准。使用RevMan和TSA软件对这些数据进行系统分析。
本研究使用的18项RCT共纳入2312例患者，胶水组1149例，钉合器组1163例。胶水固定显著降低了血肿形成风险[MD（95%CI）：0.35（0.17 - 0.73），P < 0.01]。胶水固定导致的急性疼痛[MD（95%CI）： - 1.80（ - 2.71至 - 0.89），P < 0.01]和慢性疼痛[MD（95%CI）：0.42（0.27 - 0.64），P < 0.01]明显更少。与钉合器固定相比，胶水固定还使患者能显著更快恢复正常活动/工作[MD（95%CI）： - 1.92（ - 3.17至 - 0.67），P < 0.01]。TSA证实，与钉合器固定相比，胶水固定显著降低了早期疼痛评分（<3个月）和血肿发生率。
在减少术后疼痛和血肿方面，胶水固定补片优于钉合器，这意味着患者恢复工作/活动的速度明显更快。在为患者进行腹腔镜腹股沟疝和股疝修补术的知情同意过程中，外科医生应了解这些益处。
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