Comparison of the efficacy of self-gripping mesh and sutured mesh in lichtenstein inguinal hernia repair: a meta-analysis and GRADE assessment

Abstract

Lichtenstein inguinal hernia repair is a common surgical procedure. Self-gripping mesh, a novel mesh that does not require suturing, has emerged as a potential alternative to traditional sutured mesh. This study aimed to evaluate the efficacy differences between self-gripping and sutured meshes in this surgery through a meta-analysis. Randomized controlled trials (RCTs) that met the inclusion criteria were identified through database searches in PubMed, Embase, Cochrane Library, and Web of Science. Meta-analysis was performed using Cochrane RevMan 5.4 software, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Nineteen RCTs involving 4301 patients were included. The meta-analysis showed that compared to the sutured mesh group, the self-gripping mesh group had significantly shorter surgical time [mean difference (MD) = -6.99 min, 95% confidence interval (CI) (-8.73, -5.25), P < 0.00001], and a lower postoperative 24-hour pain score [MD = -1.51, 95% CI (-2.95, -0.07), P = 0.04]. No significant differences were observed between the two groups regarding length of hospital stay, 1-year postoperative chronic pain incidence, 2-year postoperative chronic pain incidence, seroma incidence, hematoma incidence, and recurrence rate. No significant publication bias was found. GRADE assessment showed that the quality of evidence for surgical time, length of hospital stay, and 24-hour postoperative pain score was low, while other outcomes were of moderate quality. Current evidence suggests that self-gripping mesh may reduce surgical time and early postoperative pain in Lichtenstein inguinal hernia repair. However, given the low quality of evidence for these outcomes, the findings should be interpreted cautiously. Further high-quality RCTs are needed to confirm these findings.