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Efficacy and safety of mesh in open surgery for groin hernia: a systematic review and meta-analysis
Poster Abstracts
Efficacy and safety of mesh in open surgery for groin hernia: a systematic review and meta-analysis Xueli Jia, Michelle Hsin Xuan Ting, Wen Ling Choong, Diane Hildebrand, Natasha Ross, Angarahad Jones, Kathleen Irvine*, Angus J M Watson
Abstract Background The efficacy and safety of mesh in open surgery for groin hernia is uncertain. We aimed to answer this question in a Cochrane review on mesh in open surgery for groin hernia.
Published Online February 26, 2014 Poster 8
Methods To find relevant randomised controlled trials (RCTs), we searched electronic databases and conference proceedings, and scanned reference lists of retrieved papers. Two reviewers independently screened titles and abstracts, extracted data, and assessed study quality. We compared the efficacy and safety between procedures that used mesh versus no mesh, between different types of mesh for the same technique, and between different techniques that used mesh. Findings 68 RCTs with over 10 000 patients were included, of which 26 RCTs compared mesh with no mesh, 14 RCTs compared different types of mesh in the same technique, 26 RCTs compared the different techniques that use mesh, and two were ongoing RCTs. The study quality was generally moderate. Median follow-up was 24 months (IQR 12–36). Open groin hernia repair with mesh resulted in significantly reduced hernia recurrence rates compared with no mesh (24 RCTs reporting on hernia recurrence, n=4621, 1·3% [32/2391] vs 4·8% [107/2230]; relative risk [RR] 0·34, 95% CI 0·23–0·53) with no increase in the risk of persisting pain after procedures. There were no significant differences in the rate of hernia recurrence between heavy-weight and light-weight non-absorbable mesh or in the risk of persisting pain. Non-absorbable mesh had a slightly lower hernia recurrence rate than did partially absorbable mesh (eight RCTs, n=1794, 2·0% [18/883] vs 3·0% [27/911]; RR 0·78, 95% CI 0·41–1·49) but had a significantly higher risk of persisting pain after procedure (seven RCTs, n=1682, 13·7% [114/830] vs 9·5% [81/852]; RR 1·75, 95% CI 1·09–2·84). There was no significant difference between non-absorbable mesh and biological graft in hernia recurrence rate or persisting pain after procedure; however, the results were based on three small scale RCTs (n=70, n=97, n=30). Hernia recurrence rates did not differ between Lichtenstein mesh technique and other mesh techniques including Prolene Hernia System, PerFix Plug, and preperitoneal mesh repair, nor in persisting pain.
*Mrs Irvine died in May, 2013 Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK (X Jia PhD); Department of General Surgery, Raigmore Hospital, Inverness, UK (M H X Ting MSc, D Hildebrand MBChB, N Ross MBChB, A Jones MBChB, Prof A J M Watson MBChB); Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK (W L Choong MBChB); and Highland Health Sciences Library, Inverness, UK (K Irvine BSc) Correspondence to: Dr Xueli Jia, Leeds Vascular Institute, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK [email protected]
Interpretation Use of mesh in open hernia repair significantly reduced recurrence rates. Rigorous long-term RCTs are needed to determine the comparative efficacy and cost-effectiveness of biological graft, and the differences in efficacy and safety between different types of procedures that use mesh. Funding HS Highland Research and Development Committee. Contributors XJ designed and wrote the review draft; collected, analysed, and interpreted the data; and supervised and coordinated the reviewers of the systematic review. MHXT and WLC were involved with data collection and commenting on the studies included. DH, NR, and AJ commented on protocol and successive drafts of the abstract. KI contributed to data collection and commented on the study protocol and successive drafts of the abstract. AJMW provided general advice on the systematic review and contributed to the interpretation of the data, commented on successive drafts of the abstract, and coordinated the review process. Conflicts of interest We declare that we have no conflicts of interest.
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Efficacy and safety of mesh in open surgery for groin hernia: a systematic review and meta-analysis Xueli Jia, Michelle Hsin Xuan Ting, Wen Ling Choong, Diane Hildebrand, Natasha Ross, Angarahad Jones, Kathleen Irvine*, Angus J M Watson
Abstract Background The efficacy and safety of mesh in open surgery for groin hernia is uncertain. We aimed to answer this question in a Cochrane review on mesh in open surgery for groin hernia.
Published Online February 26, 2014 Poster 8
Methods To find relevant randomised controlled trials (RCTs), we searched electronic databases and conference proceedings, and scanned reference lists of retrieved papers. Two reviewers independently screened titles and abstracts, extracted data, and assessed study quality. We compared the efficacy and safety between procedures that used mesh versus no mesh, between different types of mesh for the same technique, and between different techniques that used mesh. Findings 68 RCTs with over 10 000 patients were included, of which 26 RCTs compared mesh with no mesh, 14 RCTs compared different types of mesh in the same technique, 26 RCTs compared the different techniques that use mesh, and two were ongoing RCTs. The study quality was generally moderate. Median follow-up was 24 months (IQR 12–36). Open groin hernia repair with mesh resulted in significantly reduced hernia recurrence rates compared with no mesh (24 RCTs reporting on hernia recurrence, n=4621, 1·3% [32/2391] vs 4·8% [107/2230]; relative risk [RR] 0·34, 95% CI 0·23–0·53) with no increase in the risk of persisting pain after procedures. There were no significant differences in the rate of hernia recurrence between heavy-weight and light-weight non-absorbable mesh or in the risk of persisting pain. Non-absorbable mesh had a slightly lower hernia recurrence rate than did partially absorbable mesh (eight RCTs, n=1794, 2·0% [18/883] vs 3·0% [27/911]; RR 0·78, 95% CI 0·41–1·49) but had a significantly higher risk of persisting pain after procedure (seven RCTs, n=1682, 13·7% [114/830] vs 9·5% [81/852]; RR 1·75, 95% CI 1·09–2·84). There was no significant difference between non-absorbable mesh and biological graft in hernia recurrence rate or persisting pain after procedure; however, the results were based on three small scale RCTs (n=70, n=97, n=30). Hernia recurrence rates did not differ between Lichtenstein mesh technique and other mesh techniques including Prolene Hernia System, PerFix Plug, and preperitoneal mesh repair, nor in persisting pain.
*Mrs Irvine died in May, 2013 Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK (X Jia PhD); Department of General Surgery, Raigmore Hospital, Inverness, UK (M H X Ting MSc, D Hildebrand MBChB, N Ross MBChB, A Jones MBChB, Prof A J M Watson MBChB); Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK (W L Choong MBChB); and Highland Health Sciences Library, Inverness, UK (K Irvine BSc) Correspondence to: Dr Xueli Jia, Leeds Vascular Institute, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK [email protected]
Interpretation Use of mesh in open hernia repair significantly reduced recurrence rates. Rigorous long-term RCTs are needed to determine the comparative efficacy and cost-effectiveness of biological graft, and the differences in efficacy and safety between different types of procedures that use mesh. Funding HS Highland Research and Development Committee. Contributors XJ designed and wrote the review draft; collected, analysed, and interpreted the data; and supervised and coordinated the reviewers of the systematic review. MHXT and WLC were involved with data collection and commenting on the studies included. DH, NR, and AJ commented on protocol and successive drafts of the abstract. KI contributed to data collection and commented on the study protocol and successive drafts of the abstract. AJMW provided general advice on the systematic review and contributed to the interpretation of the data, commented on successive drafts of the abstract, and coordinated the review process. Conflicts of interest We declare that we have no conflicts of interest.
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61