title: Sac ligation in inguinal hernia repair: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Traditionally, hernia sac ligation during inguinal hernia repair is considered mandatory to prevent postoperative development of hernia. However, ligation may induce postoperative pain. The aim of this study was to evaluate the outcomes of hernia sac ligation after inguinal hernia repair.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the outcomes of hernia sac ligation for open or laparoscopic inguinal hernia repair. Incidence of hernia recurrence was assessed following the surgery. The secondary outcomes included pain scores and postoperative complications.
  
  
  RESULTS
  Five trials were selected and their results were summarized. These 5 trials were published between 1984 and 2014, and the sample sizes ranged from 50 to 467 patients. Four trials had recruited patients with inguinal hernia who underwent open repair, and one study enrolled patients who underwent laparoscopic procedures. We observed no difference in the incidence of hernia recurrence and postoperative complications between the sac ligation and nonligation groups. Postoperatively, the intensity of pain was significantly higher in the ligation group than in the nonligation group at Day 7 (Weight mean difference 1.46; 95% confident interval: 0.98-1.95).
  
  
  CONCLUSIONS
  Hernia sac ligation was associated with higher postoperative pain, and did not show any benefit over sac nonligation regarding the incidence of recurrence and postoperative complications in patients undergoing open tension-free mesh repair or laparoscopic procedures.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Kao
authors.affiliation: Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Ching-Li
authors.initials: CL
authors.lastname: Li
authors.affiliation: Center for Evidence-Based Health Care, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Chao-Chun
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Su
authors.affiliation: Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Chia-Che
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Department of Surgery, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan; Center for Evidence-Based Health Care, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: kelvintam@h.tmu.edu.tw.
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation; D016032:Randomized Controlled Trials as Topic
keywords: Hernia sac; Inguinal hernia repair; Ligation; Meta-analysis; Postoperative pain