title: A meta-analysis examining the use of tacker fixation versus no-fixation of mesh in laparoscopic inguinal hernia repair.
abstract: OBJECTIVE
  The objective of this article is to systematically analyse the randomised, controlled trials comparing tacker mesh fixation (TMF) versus no-mesh fixation (NMF) in laparoscopic inguinal hernia repair (LIHR).
  
  
  METHODS
  Randomised, controlled trials comparing TMF versus NMF in LIHR were analysed systematically using RevMan(®), and combined outcomes were expressed as risk ratio (RR) and standardised mean difference (SMD).
  
  
  RESULTS
  Eight randomised, controlled trials encompassing 1386 patients were retrieved from the electronic databases. There were 691 patients in the TMF group and 695 patients in the NMF group. Statistically there was non-significant heterogeneity among trials. In random effects models, operating time (p = 0.15), post-operative pain (p = 0.45), post-operative complications (p = 0.55) and length of hospital stay (p = 0.11) were statistically comparable between two techniques of mesh fixation in LIHR. The risk of developing chronic groin pain (p = 0.67) and risk of hernia recurrence (p = 0.77) was also similar.
  
  
  CONCLUSIONS
  NMF in LIHR does not increase the risk of hernia recurrence. It is comparable with TMF in terms of operation time, post-operative pain, post-operative complications, length of hospital stay and chronic groin pain. Therefore, based upon the results of this review NMF approach may be adopted routinely and safely in LIHR.
authors.affiliation: Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex BN11 2DH, United Kingdom. surgeon1wrh@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: N
authors.initials: N
authors.lastname: Ladwa
authors.forename: L
authors.initials: L
authors.lastname: Kalra
authors.forename: K
authors.initials: K
authors.lastname: Hutson
authors.forename: P
authors.initials: P
authors.lastname: Sains
authors.forename: M K
authors.initials: MK
authors.lastname: Baig
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D010149:Postoperative Pain; D012008:Recurrence; D053831:Surgical Fixation Devices; D013526:Surgical Mesh