Pain and Surgical Outcomes Reporting After Laparoscopic Ventral Hernia Repair in Relation to Mesh Fixation Technique: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

The aim of this meta-analysis was to examine postoperative pain and surgical outcomes (operative time, hospital stay, the incidence of seroma and recurrence) with different mesh fixation methods following laparoscopic ventral hernia repair (LVHR). Randomized clinical trials compared different methods of mesh fixation in LVHR and reported on pain outcome measures analyzed. The results were expressed as odds ratio (OR) for combined dichotomous and mean difference (MD) for continuous data. Five randomized controlled trials (RCTs) with a total of 466 patients comparing tack mesh fixation to suture mesh fixation technique in LVHR were identified, all were published after 2005. A meta-analysis gave statistically similar odds of postoperative chronic pain (OR, 1.24; 95% CI, 0.65-2.38; z = 0.65; P = .51). No difference in pain intensity (PI) scores was found at 4-6 weeks (MD, 0.18;% CI, -0.48 to 0.85; z = 0.54; P = .59) and at 3-6 months postoperatively (MD, 0.10; 95% CI, -0.21 to 0.42; z = 0.64; P = .52). There was no difference in the pooled analysis of seroma/hematoma formation (OR, 0.60; 95% CI, 0.29-1.26; z = 1.35; P = .18), recurrence (OR, 1.11; 95% CI, 0.34-3.62; z = 0.18; P = .86), and hospital stay (MD, -0.06; 95% CI, -0.19 to 0.08; z = 0.83; P = .40). Operative time was significantly lower with tack fixation (MD, -19.25; 95% CI, -27.98 to -10.51; z = 4.32; P < .05). Meta-analysis of RCTs comparing tacks to suture fixation in LVHR showed comparable results with regard to postoperative chronic pain incidence and PI, and hernia recurrence. However, the operative time is shorter with tacks compared to suture fixation technique.