title: Mesh fixation methods in open inguinal hernia repair: a protocol for network meta-analysis and trial sequential analysis of randomised controlled trials.
abstract: BACKGROUND
  Randomised clinical trials (RCTs) have been used to compare and evaluate different types of mesh fixation usually employed to repair open inguinal hernia. However, there is no consensus among surgeons on the best type of mesh fixation method to obtain optimal results. The choice often depends on surgeons' personal preference. This study aims to compare different types of mesh fixation methods to repair open inguinal hernias and their role in the incidences of chronic groin pain, risk of hernia recurrence, complications, operative time, length of hospital stay and postoperative pain, using Bayesian network meta-analysis and trial sequential analysis of RCTs.
  
  
  METHODS
  A systematic search will be performed using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database, to include RCTs of different mesh fixation methods (or fixation vs no fixation) during open inguinal hernia repair. The risk of bias in included RCTs will be evaluated according to the Cochrane Handbook V.5.1.0. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be performed to compare the efficacy of different mesh fixation methods.
  
  
  BACKGROUND
  Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis and trial sequential analysis will be submitted to a peer-reviewed journal for publication.
  PROSPERO CRD42015023758.
authors.affiliation: The First Clinical Medical College of Lanzhou University, Lanzhou, China Evidence-based Medicine Center of Lanzhou University, Lanzhou, China Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
authors.forename: Long
authors.initials: L
authors.lastname: Ge
authors.affiliation: Evidence-based Medicine Center of Lanzhou University, Lanzhou, China Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
authors.forename: Jin-hui
authors.initials: JH
authors.lastname: Tian
authors.affiliation: Department of Breast-Thyroid Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Lun
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Four Military Medical University, Xi'an, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Evidence-based Medicine Center of Lanzhou University, Lanzhou, China Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
authors.forename: Ke-hu
authors.initials: KH
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D002985:Clinical Protocols; D006119:Groin / Q000473:pathology / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012107:Research Design; D015201:Meta-Analysis as Topic
keywords: COMPLEMENTARY MEDICINE; STATISTICS & RESEARCH METHODS; SURGERY