Key messages
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Choosing to fix the patch with glue or a self-sticking patch compared to using stitches, tacks, or staples may make little to no difference to the risk of long-term pain and the hernia coming back.
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Fixing the patch with glue or a self-sticking patch may reduce the risk of blood collecting under the skin compared with using stitches, tacks, or staples.
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We generally have little or very little confidence in the results, meaning the results should be interpreted carefully.
What is a groin hernia?
A groin hernia happens when abdominal content, like part of the intestine or fat, pushes through a weak spot in the groin. A hernia causes a bulge and sometimes pain. Groin hernias are common and typically require surgery as they do not go away without surgery.
How is a groin hernia treated?
A groin hernia can be treated by a keyhole operation where surgeons make small cuts in the abdomen and use special tools to fix the groin hernia from inside the abdomen. Surgeons place a patch over the weak area in the groin to support it. The patch can be attached using glue or special self-sticking patches (named ‘non-penetrating patch fixation’ in this review) or using sharp tools like stitches, tacks, or staples (named ‘penetrating patch fixation’ in this review).
What did we want to find out?
We wanted to find out whether non-penetrating or penetrating patch fixation was more effective in reducing pain, preventing the hernia from coming back, and avoiding other problems during and after surgery.
What did we do?
We looked for studies where adults with groin hernias were randomly assigned to non-penetrating or penetrating patch fixation during keyhole surgery. We combined the results of these studies and assessed how trustworthy the evidence was.
What did we find?
We found 35 studies involving 4329 adults. About half of the participants had non-penetrating patch fixation, and the other half had penetrating patch fixation. Most participants were men aged between 37 and 66 years. The most common type of hernia was a first-time-occurring hernia on one side of the groin. Most studies compared fixing the patch with glue compared to using staples or tacks. The studies were of varying size, with between 30 and 600 people each, and follow-up time varied from a few days up to 56 months after surgery. Most of the included studies were from Asia or Europe.
What are the main results?
Non-penetrating patch fixation may make little to no difference to the risk of long-term pain and the hernia coming back after surgery. Non-penetrating patch fixation may reduce the risk of blood collecting under the skin in the groin compared with penetrating patch fixation, but we are not confident in this evidence. We do not know if the type of patch fixation has an effect on short-term pain, infections of the patch, how long the surgery takes, or if it prolongs how quickly people return to normal activities.
What are the limitations of the evidence?
A limitation is that we have little confidence in the evidence. This is mainly due to studies not reporting all relevant information or because there are not enough studies to be certain about the results of the outcomes.
How up to date is this evidence?
The evidence is up to date to 14 November 2024.
Baca abstrak penuh
Matlamat
To assess the benefits and harms of penetrating versus non-penetrating mesh fixation in adults undergoing laparoscopic groin hernia repair.
Kaedah Pencarian
We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ClinicalTrials.gov, and the WHO International Clinical Trial Registry Platform. Additionally, we performed reference checking, forward and backward citation searching, and contacted study authors to identify eligible studies. The latest search date was 14 November 2024.
Kesimpulan Pengarang
There may be little to no difference between non-penetrating and penetrating mesh fixation regarding the risk of chronic pain (dichotomous), recurrence, acute pain (dichotomous), mesh infections, and operative time, but the evidence is very uncertain. Non-penetrating mesh fixation may result in little to no difference in serious vascular intraoperative events.
While the evidence is very uncertain, non-penetrating mesh fixation may slightly reduce the level of chronic pain (continuous), the level of acute pain (continuous), and the risk of haematoma, and shorten convalescence (dichotomous and continuous).
Overall, this review demonstrated little to no difference in clinically important outcomes between penetrating and non-penetrating mesh fixation in laparoscopic groin hernia repair in adults, based on low- to very low-certainty evidence.
Pembiayaan
This Cochrane review had no dedicated funding.
Pendaftaran
Protocol available via DOI: 10.1002/14651858.CD016122.
