Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis

Tao Jiang; Chen Zhang; Xiao-Ling Wang; Da-Chun Yue; Xiao-Ping Yuan; Deng-Chao Wang

doi:10.1186/s12893-024-02628-4

Meta-analysis of RCTs on the safety of non-fixation of mesh in TAPP inguinal hernia repair: an updated meta-analysis

BMC Surg. 2024 Oct 17;24(1):317. doi: 10.1186/s12893-024-02628-4.

Authors

Tao Jiang^#¹, Chen Zhang^#^{2

3}, Xiao-Ling Wang⁴, Da-Chun Yue⁵, Xiao-Ping Yuan⁵, Deng-Chao Wang¹

Affiliations

¹ Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China.
² Department of Trauma Center, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China. zhangchensurgery@163.com.
³ Department of Orthopedics, People's Hospital of Pingchang County, Pingchang, Sichuan, 636400, China. zhangchensurgery@163.com.
⁴ Department of Network Engineering, School of Computer Science and Engineering, Sichuan University of Science & Engineering, Zigong, Sichuan, 643000, China.
⁵ Department of Orthopedics, People's Hospital of Pingchang County, Pingchang, Sichuan, 636400, China.

^# Contributed equally.

PMID: 39420306
DOI: 10.1186/s12893-024-02628-4

Abstract

Objective: This meta-analysis aims to compare the clinical efficacy of mesh non-fixation and fixation in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair, systematically evaluating the application value of the mesh non-fixation technique in clinical settings.

Methods: A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases was conducted to identify randomized controlled trials (RCTs) comparing mesh non-fixation and fixation in TAPP inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence grading system was employed for outcome quality assessment. Publication bias analysis was performed using Begg's test. A trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software.

Results: A total of nine RCTs involving 1,879 inguinal hernia patients were included. Meta-analysis results demonstrated that, compared to the fixation group, the non-fixation group exhibited significantly lower seroma occurrence rate [RR = 0.43, 95% CI (0.20, 0.89), P = 0.02, heterogeneity P = 0.28, I²=22%], Visual Analog Scale (VAS) pain score at 6 months postoperatively [MD=-0.21, 95% CI (-0.29, -0.12), P < 0.00001, heterogeneity P = 0.34, I²=0%], and cost [MD=-3.23 thousand yuan, 95% CI (-4.26, -2.19), P < 0.00001, heterogeneity P = 0.0003, I²=92%]. There were no statistically significant differences in overall complication rate [RR = 0.88, 95% CI (0.62, 1.23), P = 0.45, heterogeneity P = 0.11, I²=44%], overall infection event rate [RR = 0.96, 95% CI (0.36, 2.56), P = 0.93, heterogeneity P = 0.62, I²=0%] and recurrence rate [RR = 0.75, 95% CI (0.28, 1.99), P = 0.56, heterogeneity P = 0.44, I²=0%] between the two groups. The results of the TSA indicated that the observed lower seroma occurrence rate in the non-fixation group compared to the fixation group requires further validation through the inclusion of additional RCTs.

Conclusion: Mesh non-fixation in TAPP inguinal hernia repair is deemed safe and does not elevate the risk of hernia recurrence. However, given certain limitations in this study, future comprehensive and reliable validation will require further multicenter, high-quality, large-sample double-blind RCTs.

Keywords: Inguinal hernia; Mesh; Meta-analysis; TAPP.