title: Self-gripping versus sutured mesh fixation methods for open inguinal hernia repair: A systematic review of clinical trials and observational studies.
abstract: We performed this systematic review and meta-analysis to compare the outcomes of Lichenstein hernia repair using either self-gripping mesh or techniques of sutured mesh fixation.
  
  
  
  We searched PubMed, Cochrane CENTRAL, Scopus, Embase, and Web of Science for all clinical trials and observational studies that compared self-gripping mesh versus sutured mesh fixation in Lichtenstein hernia repair. Combined outcomes were pooled as odds ratios or mean differences in a fixed-effect model, using Comprehensive Meta-Analysis software for Windows.
  
  
  
  Twelve randomized, controlled trials and 5 cohort studies (n = 3,722 patients) were included in the final analysis. The two groups, using self-gripping mesh or sutured mesh fixation, did not differ significantly in terms of recurrence rate (odds ratio = 0.66, 95% confidence interval 0.18-2.44; P = .54) or postoperative chronic groin pain (odds ratio = 0.75, 95% confidence interval 0.54-1.05; P = .09). The operative time was less in the self-gripping mesh group (mean difference = -7.85, 95% confidence interval -9.94 to -5.76; P < .0001). For safety analysis, there were comparable risks between self-gripping mesh and sutured mesh fixation groups in terms of postoperative infection (odds ratio = 0.81, 95% confidence interval 0.53-1.23; P = .32), postoperative hematoma (odds ratio = 0.97, 95% confidence interval 0.7-1.36; P = .9), and urinary retention (odds ratio = 0.66, 95% confidence interval 0.18-2.44; P = .54).
  
  
  
  Data from our analysis did not favor either of the two fixation techniques over the other in terms of recurrence or postoperative chronic groin pain. Decreased operative time in the self-gripping mesh group cannot justify a recommendation for its routine use. Longer follow-up studies are needed to compare the risk of long-term recurrence for both meshes.
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt; Medical Research Group of Egypt, Cairo, Egypt.
authors.forename: Ammar
authors.initials: A
authors.lastname: Ismail
authors.affiliation: NovaMed Medical Research Association, Cairo, Egypt; Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: Abdelrahman.abushouk@med.asu.edu.eg.
authors.forename: Abdelrahman Ibrahim
authors.initials: AI
authors.lastname: Abushouk
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt; Medical Research Group of Egypt, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elmaraezy
authors.affiliation: NovaMed Medical Research Association, Cairo, Egypt; Faculty of Medicine, Zagazig University, El-Sharkia, Egypt; Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Ahmed Helal
authors.initials: AH
authors.lastname: Abdelkarim
authors.affiliation: NovaMed Medical Research Association, Cairo, Egypt; Faculty of Medicine, Zagazig University, El-Sharkia, Egypt; Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shehata
authors.affiliation: Faculty of Medicine, Al-Azhar University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abozaid
authors.affiliation: NovaMed Medical Research Association, Cairo, Egypt; Faculty of Medicine, Zagazig University, El-Sharkia, Egypt; Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Hussien
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: NovaMed Medical Research Association, Cairo, Egypt; Faculty of Medicine, Zagazig University, El-Sharkia, Egypt; Student Research Unit, Zagazig University, El-Sharkia, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Negida
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D013526:Surgical Mesh; D013536:Suture Techniques