title: A meta-analysis of randomized controlled trials of fixation versus nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernia repair.
abstract: BACKGROUND
  Mesh fixation during laparoscopic total extraperitoneal (TEP) inguinal hernia repair is still controversial. Although many surgeons considered it necessary to fix the mesh, some published studies supported elimination of mesh fixation. Therefore, a meta-analysis based on randomized controlled trials (RCTs) was conducted to compare the effectiveness and safety of fixation versus nonfixation of mesh in TEP.
  
  
  METHODS
  RCTs were identified from PubMed, Embase, the Cochrane Library, SCI, and the Chinese Biomedical Literature Database (CBM). Two reviewers assessed the quality of the studies and extracted data independently. The methodological quality was evaluated according to the Cochrane Handbook 5.0.2. Statistical analysis was conducted using the Cochrane software RevMan 5.0.21.
  
  
  RESULTS
  Six RCTs involving 772 patients were included. The nonfixation group had advantages in length of hospital stay [MD =-0.37, 95% CI (-0.57, -0.17), p = 0.0003], operative time [MD = -4.19, 95% CI (-7.77, -0.61), p = 0.02], and costs. However, there was no statistically significant difference in hernia recurrence [OR = 2.01, 95% CI (0.37, 11.03), p = 0.42], time to return to normal activities [MD = -0.13, 95% CI (-0.45, 0.19), p = 0.43], seroma [OR = 1.25, 95% CI (0.30, 5.18), p = 0.75], and postoperative pain on postoperative day 1 [MD = -0.21, 95% CI (-0.52, 0.10), p = 0.18] and day 7 [MD = -0.11, 95% CI (-0.42, 0.20), p = 0.47].
  
  
  CONCLUSIONS
  Without increasing the risk of early hernia recurrence, the nonfixation of mesh in TEP appears to be a safe alternative that is associated with less costs, shorter operative time, and hospital stay for the selected patients. Further adequately powered RCTs are required to clarify whether mesh fixation is necessary for the patients with different types of hernias and larger hernia defects.
authors.affiliation: Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Dong Gang West Road No. 199, Chengguan, Lanzhou, Gansu 730000, China.
authors.forename: Yuan Jun
authors.initials: YJ
authors.lastname: Teng
authors.forename: Shu Mei
authors.initials: SM
authors.lastname: Pan
authors.forename: Ya Li
authors.initials: YL
authors.lastname: Liu
authors.forename: Ke Hu
authors.initials: KH
authors.lastname: Yang
authors.forename: You Cheng
authors.initials: YC
authors.lastname: Zhang
authors.forename: Jin Hui
authors.initials: JH
authors.lastname: Tian
authors.forename: Jian Xu
authors.initials: JX
authors.lastname: Han
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery; D059685:Herniorrhaphy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000453:epidemiology; D059348:Peripheral Nerve Injuries / Q000191:economics / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D015983:Selection Bias; D049291:Seroma / Q000453:epidemiology; D016037:Single-Blind Method; D013526:Surgical Mesh / Q000191:economics; D013536:Suture Techniques / Q000191:economics; D016896:Treatment Outcome