Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials

Adrian Maxwell Grant, P. M. Go, A. Fingerhut, A. Kingsnorth, J. Merello, P. O'Dwyer, J. Payne, Kirsty McCormack, S. Ross, Neil William Scott, Luke David Vale, EU Hernia Trialists Collaboration

Research output: Contribution to journalArticle

302 Citations (Scopus)

Abstract

Objective To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair.

Summary Background Data Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain.

Methods Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat.

Results There were 62 relevant comparisons in 58 trials. These included 11, 174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% CI 0.34-0.55; P <.001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% CI 0.29-0.46; P <.001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% CI 0.76-2.08; P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% CI 0.52-0.78; P <.001).

Conclusions The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method, Mesh repair appears to reduce the chance of persisting pain rather than increase it.

Original languageEnglish
Pages (from-to)322-332
Number of pages10
JournalAnnals of Surgery
Volume235
Issue number3
DOIs
Publication statusPublished - Mar 2002

Keywords

  • OPEN INGUINAL HERNIORRHAPHY
  • TENSION-FREE HERNIOPLASTY
  • DAY SURGICAL-PROCEDURE
  • SHOULDICE TECHNIQUE
  • POSTOPERATIVE PAIN
  • TRANSABDOMINAL PREPERITONEAL
  • LAPAROSCOPIC SURGERY
  • MULTICENTER TRIAL
  • BASSINI REPAIR
  • LICHTENSTEIN

Cite this

Grant, A. M., Go, P. M., Fingerhut, A., Kingsnorth, A., Merello, J., O'Dwyer, P., ... EU Hernia Trialists Collaboration (2002). Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Annals of Surgery, 235(3), 322-332. https://doi.org/10.1097/00000658-2002030

Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. / Grant, Adrian Maxwell; Go, P. M.; Fingerhut, A.; Kingsnorth, A.; Merello, J.; O'Dwyer, P.; Payne, J.; McCormack, Kirsty; Ross, S.; Scott, Neil William; Vale, Luke David; EU Hernia Trialists Collaboration.

In: Annals of Surgery, Vol. 235, No. 3, 03.2002, p. 322-332.

Research output: Contribution to journalArticle

Grant, AM, Go, PM, Fingerhut, A, Kingsnorth, A, Merello, J, O'Dwyer, P, Payne, J, McCormack, K, Ross, S, Scott, NW, Vale, LD & EU Hernia Trialists Collaboration 2002, 'Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials', Annals of Surgery, vol. 235, no. 3, pp. 322-332. https://doi.org/10.1097/00000658-2002030
Grant AM, Go PM, Fingerhut A, Kingsnorth A, Merello J, O'Dwyer P et al. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Annals of Surgery. 2002 Mar;235(3):322-332. https://doi.org/10.1097/00000658-2002030
Grant, Adrian Maxwell ; Go, P. M. ; Fingerhut, A. ; Kingsnorth, A. ; Merello, J. ; O'Dwyer, P. ; Payne, J. ; McCormack, Kirsty ; Ross, S. ; Scott, Neil William ; Vale, Luke David ; EU Hernia Trialists Collaboration. / Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. In: Annals of Surgery. 2002 ; Vol. 235, No. 3. pp. 322-332.
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abstract = "Objective To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair.Summary Background Data Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain.Methods Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat.Results There were 62 relevant comparisons in 58 trials. These included 11, 174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95{\%} CI 0.34-0.55; P <.001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95{\%} CI 0.29-0.46; P <.001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95{\%} CI 0.76-2.08; P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95{\%} CI 0.52-0.78; P <.001).Conclusions The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method, Mesh repair appears to reduce the chance of persisting pain rather than increase it.",
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TY - JOUR

T1 - Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials

AU - Grant, Adrian Maxwell

AU - Go, P. M.

AU - Fingerhut, A.

AU - Kingsnorth, A.

AU - Merello, J.

AU - O'Dwyer, P.

AU - Payne, J.

AU - McCormack, Kirsty

AU - Ross, S.

AU - Scott, Neil William

AU - Vale, Luke David

AU - EU Hernia Trialists Collaboration

PY - 2002/3

Y1 - 2002/3

N2 - Objective To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair.Summary Background Data Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain.Methods Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat.Results There were 62 relevant comparisons in 58 trials. These included 11, 174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% CI 0.34-0.55; P <.001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% CI 0.29-0.46; P <.001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% CI 0.76-2.08; P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% CI 0.52-0.78; P <.001).Conclusions The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method, Mesh repair appears to reduce the chance of persisting pain rather than increase it.

AB - Objective To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair.Summary Background Data Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain.Methods Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat.Results There were 62 relevant comparisons in 58 trials. These included 11, 174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% CI 0.34-0.55; P <.001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% CI 0.29-0.46; P <.001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% CI 0.76-2.08; P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% CI 0.52-0.78; P <.001).Conclusions The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method, Mesh repair appears to reduce the chance of persisting pain rather than increase it.

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KW - TENSION-FREE HERNIOPLASTY

KW - DAY SURGICAL-PROCEDURE

KW - SHOULDICE TECHNIQUE

KW - POSTOPERATIVE PAIN

KW - TRANSABDOMINAL PREPERITONEAL

KW - LAPAROSCOPIC SURGERY

KW - MULTICENTER TRIAL

KW - BASSINI REPAIR

KW - LICHTENSTEIN

U2 - 10.1097/00000658-2002030

DO - 10.1097/00000658-2002030

M3 - Article

VL - 235

SP - 322

EP - 332

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -