Abstract

DOMINGUEZ, Luis Carlos; SANABRIA, Álvaro; VEGA, Neil Valentín  and  OSORIO, Camilo. Should mesh prosthesis be fixed in inguinal herniorraphy?. rev. colomb. cir. [online]. 2012, vol.27, n.3, pp.202-212. ISSN 2011-7582.

Introduction / aims: Mesh fixation in groin hernia repair has been recommended routinely; however there is pertinent controversial information. In this study we review the clinical effectiveness of the intervention in open (Lichtenstein repair) and laparoscopic repair. Methods: We used a Best Bets methodology to identify clinical trials comparing mesh fixation versus no mesh fixation during inguinal herniorraphy. Studies were evaluated according with JAMA criteria. Information about clinical effectiveness was extracted from articles, and we considered as primary outcomes the recurrence rate, postoperative pain, and development of infection, seroma, and hematoma. Secondary outcomes were cost, length of stay, operating time, and return to labor activity. Results: One systematic review and nine RCT were identified. In TEP, TAPP and open repair there is no difference in the recurrence rate or in the development of infection, seroma, and hematoma. Postoperative pain decreases when mesh is unfixed in both repairs. For laparoscopic repair the time to return labor activity is not modified under mesh fixation. Fixation increases cost and operative time. Conclusions: Fixation could be omitted during laparoscopic and Lichtenstein repair. Main advantage of non fixation is related to the reduction of postoperative pain, with no modifications in recurrence rate. There is no information regarding other surgical techniques such as the preperitoneal repair (Nyhus procedure).

Keywords : hernia; inguinal; prostheses and implants; surgical mesh; surgical fixation devices; pain; postoperative.

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