Glue versus absorbable tacks for mesh fixation in laparoscopic inguinal hernia repair: a systematic review and meta-analysis of postoperative pain and complications.
Caio Pluvier Duarte Costa, Ana Paula Valerio-Alves, Rachel Gomes Boechat de Oliveira, Thablu Matheus Alves Gonzaga, Ana Beatriz de Almeida Porto Maia, Zuila Rafaella Cavalcante de Oliveira, Rafael Morriello, Marcelo Henrique Ferreira Fernandes
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引用次数: 0
Abstract
Purpose: Mesh fixation is not routinely required in most laparoscopic inguinal hernia repairs (LIHR); however, when indicated, the optimal fixation method remains uncertain. This study aimed to compare surgical glue versus absorbable tacks (AT) for mesh fixation in LIHR, focusing on postoperative pain and early complications.
Methods: We searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing glue versus AT in elective LIHR. Effect estimates were pooled using random-effects models and expressed as mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs). The primary outcome was postoperative pain assessed by the visual analogue scale (VAS). Secondary outcomes included complications and operative time. Risk of bias was assessed using the Cochrane RoB 2 tool. Trial sequential analysis (TSA) and prediction intervals (PI) were used to assess robustness.
Results: Nine RCTs comprising 1,289 patients were included. Glue fixation was associated with lower early postoperative pain at 7-14 days (MD - 0.77; 95% CI - 1.22 to - 0.33; p < 0.001; I2 = 83%). However, substantial heterogeneity and wide prediction intervals (- 2.33 to 0.79) indicated variability across settings. TSA suggested evidence of potential effect; however, this finding should be interpreted in the context of substantial heterogeneity. No significant difference was observed beyond 4 weeks, with insufficient cumulative evidence to draw firm conclusions. Glue fixation was associated with lower rates of hematoma and seroma, although the findings were uncertain given the prediction intervals and TSA. Other outcomes were underpowered or inconclusive.
Conclusion: Glue fixation may be associated with lower early postoperative pain than absorbable tacks after LIHR; however, the available evidence remains heterogeneous and inconclusive for other postoperative outcomes. Further adequately powered randomized trials are required before definitive clinical recommendations can be made.
目的：在大多数腹腔镜腹股沟疝修补术（LIHR）中，通常不需要网状物固定；然而，当指出最佳固定方法时，仍不确定。本研究旨在比较手术胶与可吸收钉（AT）用于LIHR补片固定的效果，重点关注术后疼痛和早期并发症。方法：我们检索PubMed、Embase和Cochrane，查找比较glue和AT治疗选择性LIHR的随机对照试验（rct）。使用随机效应模型汇总效果估计，并以95%置信区间（ci）的平均差异（md）或风险比（rr）表示。主要结局是术后疼痛通过视觉模拟评分（VAS）进行评估。次要结局包括并发症和手术时间。使用Cochrane RoB 2工具评估偏倚风险。使用试验序列分析（TSA）和预测区间（PI）来评估稳健性。结果：纳入9项随机对照试验，共1289例患者。胶水固定与术后7-14天较低的早期疼痛相关（MD - 0.77; 95% CI - 1.22 - 0.33; p = 83%）。然而，大量的异质性和较宽的预测区间（- 2.33至0.79）表明不同设置之间存在差异。运输安全管理局提出了潜在影响的证据；然而，这一发现应该在实质性异质性的背景下解释。4周后未观察到显著差异，累积证据不足，无法得出确切结论。胶水固定与较低的血肿和血肿发生率相关，尽管考虑到预测间隔和TSA，结果尚不确定。其他结果则不够有力或不确定。结论：与可吸收性钉相比，胶水固定可降低LIHR术后早期疼痛；然而，对于其他的术后结果，现有的证据仍然是不一致和不确定的。在提出明确的临床建议之前，需要进一步进行充分有力的随机试验。
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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