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Suture fixation versus self-gripping mesh for open inguinal hernia repair: a systematic review with meta-analysis and trial sequential analysis

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Abstract

Introduction

Morbidity following open inguinal hernia repair is mainly related to chronic pain. ProGrip™ is a self-gripping mesh which aims to reduce rates of chronic pain. The aim of this study is to perform an update meta-analysis to consolidate the non-superiority hypothesis in terms of postoperative pain and recurrence and perform a trial sequential analysis.

Methods

Systematic review of randomised controlled trials performed according to PRISMA guidelines. Pooled odds ratios with 95% confidence intervals (CI) were calculated using the Mantel–Haenszel (M–H) method. The primary outcome measure was postoperative pain and secondary outcomes were recurrence, operative time, wound complications, length of stay, re-operation rate, and cost. Trial sequential analysis was performed.

Results

There were 14 studies included in the quantitative analysis with 3180 patients randomised to self-gripping mesh (1585) or standard mesh (1595). At all follow-up time points, there was no significant difference in the rates of chronic pain between the self-gripping and standard mesh (risk ratio, RR 1.10, 95% confidence interval, CI 0.83–1.46). There were no significant differences in recurrence rates (RR 1.13, CI 0.84–2.04). The mean operating time was significantly shorted in the ProGrip™ mesh group (MD − 7.32 min, CI − 10.21 to − 4.44). Trial sequential analysis suggests findings are conclusive.

Conclusion

This meta-analysis has confirmed no benefit of a ProGrip™ mesh when compared to a standard sutured mesh for open inguinal hernia repair in terms of chronic pain or recurrence. No further trials are required to address this clinical question.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK

    N. L. Bullen & N. J. Smart

  2. Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK

    S. Hajibandeh

  3. Department of General Surgery, North Manchester General Hospital, Manchester, UK

    S. Hajibandeh

  4. Surgical Service, Mediterranean Hospital of Cyprus, Limassol, Cyprus

    S. A. Antoniou

  5. Medical School, European University Cyprus, Nicosia, Cyprus

    S. A. Antoniou

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  1. N. L. Bullen
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Correspondence to N. L. Bullen.

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Naomi L. Bullen, Shahin Hajibandeh, Shahab Hajibandeh, Neil J. Smart, Stavros A. Antoniou have no conflicts of interest or financial ties to disclose.

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Bullen, N.L., Hajibandeh, S., Hajibandeh, S. et al. Suture fixation versus self-gripping mesh for open inguinal hernia repair: a systematic review with meta-analysis and trial sequential analysis. Surg Endosc 35, 2480–2492 (2021). https://doi.org/10.1007/s00464-020-07658-6

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  • DOI: https://doi.org/10.1007/s00464-020-07658-6

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