Open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this report is to evaluate the efficacy of the 3 most common open mesh techniques used in practice.

BACKGROUND: The open mesh technique of choice, inguinal hernia repair, remains controversial. Some randomized controlled trials (RCTs) have been published assessing its effectiveness; however, available data regarding the outcomes were noncoincident. Therefore, it is necessary to carry out a meta-analysis of the evidence on outcomes for the open mesh technique.

METHODS: : A fully recursive literature search was conducted in the Cochrane Controlled Trials Register Databases, Medline, Embase, ISI databases, and Chinese Biomedical Literature Database in any language. RCTs between 1989 and 2008 of open mesh techniques were considered for inclusion. Statistical analyses were carried out using RevMan software.

RESULTS: Ten RCTs with 2708 patients were included. There was no significant difference in recurrence when comparing Lichtenstein's operation to mesh plug repair or prolene hernia system (PHS) repair (risk ratio: 0.71; 95% confidence intervals: 0.32-1.56), (risk ratio: 2.19; 95% confidence intervals: 0.63-7.62), respectively. There was insufficient evidence to determine the greater effectiveness between mesh plug repair and PHS repair.

CONCLUSIONS: Lichtenstein's operation was similar to mesh plug or PHS repair in terms of time to return to work, complications, chronic pain, and hernia recurrence in the short- to mid-term, although mesh plug and PHS repair was associated with shorter surgical time.