1. Absorbable versus non-absorbable tacks for mesh fixation in laparoscopic ventral hernia repair: A systematic review and meta-analysis
- Author
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Shahab Hajibandeh, Rao Muhammad Asaf Khan, Mumtaz Bughio, Baqar Ali, and Shahin Hajibandeh
- Subjects
medicine.medical_specialty ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Hernia ,Herniorrhaphy ,business.industry ,Absolute risk reduction ,General Medicine ,Odds ratio ,Surgical Mesh ,medicine.disease ,Hernia, Ventral ,Confidence interval ,Surgery ,Clinical trial ,030220 oncology & carcinogenesis ,Seroma ,Meta-analysis ,Surgical Fixation Devices ,Laparoscopy ,Observational study ,business - Abstract
Objectives To investigate the outcomes of absorbable versus non-absorbable tacks in patients undergoing laparoscopic ventral hernia repair. Methods We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. We conducted a search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov ; and ISRCTN Register, and bibliographic reference lists to identify all randomised controlled trials (RCTs) and observational studies investigating outcomes of absorbable versus non-absorbable tacks for mesh fixation in patients undergoing laparoscopic ventral hernia repair. We used the Cochrane risk of bias tool and the Newcastle-Ottawa scale to assess the risk of bias of RCTs and observational studies, respectively. Fixed-effect or random-effects models were applied to calculate pooled outcome data. Results We identified three RCTs and two observational studies enrolling a total of 1149 patients. The included patients were comparable in terms of age [Mean difference (MD) 0.28, 95% confidence intervals (CI) −1.45-2, P = 0.75], male gender (MD 0.81, 95% CI 0.63–1.04, P = 0.10), body mass index (MD -041, 95% CI -1.28-0.46, P = 0.36) and hernia defect size (MD 0.12, 95% CI -0.26-0.49, P = 0.54). The mean and median follow-up period was 30 months and 13 months, respectively There was no difference between the two mesh fixation techniques in terms of recurrence [Risk difference (RD) 0.03, 95% CI -0.04, 0.09, P = 0.47], chronic pain [Odds ratio (OR) 0.91, 95% CI 0.62–1.33, P = 0.64], seroma (OR 0.98, 95% CI 0.37–2.60, P = 0.96), haematoma (RD -0.00, 95% CI -0.04- 0.04, P = 0.99), prolonged ileus (OR 0.99, 95% CI 0.24–4.03, P = 0.99), length of hospital stay (MD 0.10, 95% CI -0.36-0.56, P = 0.68) and port-site hernia (OR 0.98, 95% CI 0.13–7.16, P = 0.98). The operative time was longer in absorbable tack group (MD 7.53, 95% CI 1.49–13.58, P = 0.01). The results remain consistent when randomised trials were analysed separately. Conclusions We found no difference in clinical outcomes between absorbable and non-absorbable tacks for mesh fixation in patients undergoing laparoscopic ventral hernia repair. The quality of the available evidence is moderate with a possibility of type 2 error. High quality RCTs with adequate statistical power are required to provide more robust basis for definite conclusions. Considering the similarity of both techniques in terms of clinical outcomes, the cost-effectiveness of each technique would be an important outcome determining which technique should be used; this needs to be considered as an outcome of interest in future studies.
- Published
- 2018