Artikel
Mesh fixation techniques in primary ventral or incisional hernia repair: a systematic review and meta-analysis
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Veröffentlicht: | 23. Februar 2017 |
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Background: To determine the effect of different mesh fixation techniques following primary and incisional ventral hernia repair.
Material and methods: We searched the Cochrane Colorectal Cancer Group Controlled Trials Register, CENTRAL, MEDLINE and EMBASE (09/2015). In addition we performed manual searches of specific journals, searched trial registries and contacted experts. We included randomized controlled trials (RCTs) on adult patients with primary or incisional ventral hernias that compared mesh fixation methods. Primary outcomes were recurrence and pain. Two reviewers independently selected studies and assessed the risk of bias with the Cochrane risk of bias tool. Two reviewers extracted data in standardized, piloted data extraction forms. Relative risks were calculated for binary outcomes and mean differences for continuous outcomes. We prepared GRADE summary of finding tables. Protocol registration number: CD011563.
Results: Five trials were included (430 participants). Quality of evidence was low, mainly due to imprecision and risk of bias.
The majority of participants had incisional hernias. Repairs were preformed laparoscopically in all studies.
The relative risk of recurrence were 4.82 (95% CI 0.24, 98.03; N=1) for the comparison of titanium tacks plus suture compared with suture only, 1.17 (95% CI 0.12, 11.00; N=2; I2=0) for the comparison titanium tacks plus nonabsorbable sutures compared with titanium tacks alone, 1.07 (95% CI 0.07, 16.72; N=1) for the comparison of titanium tacks plus absorbable sutures compared with titanium tacks alone and 3.00 (95% CI 0.12, 72.10; N=1) for the comparison of titanium tacks plus absorbable sutures compared with titanium tacks plus nonabsorbable sutures. Regarding the comparison of fibrin sealant with tacks, more recurrences were recognized in the fibrin glue group (RR 0.20; 95%CI 0.03, 1.55; N=1). There was no difference between tacks and sutures in terms of recurrence (RR 1.00; 95% CI 0.07, 14.79; N=1). There was no difference regarding other complications.
Conclusions: Evidence suggests fibrin sealant may be associated with higher risk of recurrence and the combination of different fixation techniques is not of advantage. The current evidence indicates that fibrin sealant alone and combinations of tacks and sutures perform worse. There seems to be no difference between tacks and sutures.