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Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis.

Identifieur interne : 000250 ( Main/Exploration ); précédent : 000249; suivant : 000251

Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis.

Auteurs : Hassen Hentati [Tunisie] ; Wajih Dougaz ; Chadli Dziri

Source :

RBID : pubmed:25135172

Descripteurs français

English descriptors

Abstract

BACKGROUND

The optimal technique to cure strangulated inguinal hernia remains controversial. The use of mesh in cases of strangulated hernia is still debated due to the potential risk of infection.

OBJECTIVE

This systematic review aimed to determine whether or not the mesh repair technique is associated with a higher risk of surgical site infection than non-mesh techniques for strangulated inguinal hernias in adults.

METHODS

An electronic search of the relevant literature was performed on 15 December 2012 using the following databases: MEDLINE, the Cochrane Library, Scopus, Embase, and the Web of Science. Articles reporting a comparison between the mesh repair technique and a non-mesh technique to treat strangulated inguinal hernias in adults, and published in the English or French language in a peer-reviewed journal, were considered for analysis. The quality of randomized controlled trials (RCTs) was assessed using the Jadad scoring system. To assess the quality of non-randomized trials, we used the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

A total of 232 papers was found in the initial search; nine were included in the meta-analysis. The wound infection rate in the mesh repair technique group was lower than in the control group, with a trend towards significance (odds ratio [OR] 0.46, 95 % confidence interval [CI] 0.20-1.07; p = 0.07). The hernia recurrence rate was lower in the mesh repair group (OR 0.2, 95 % CI 0.05-0.78; p = 0.02).

CONCLUSION

The mesh repair technique is a good option for the treatment of strangulated inguinal hernias in adults, giving an acceptable wound infection rate and fewer recurrences than non-mesh repair. Our study does not allow us to recommend the use of mesh in cases of bowel resection. We emphasize that, except the two RCTs, the results are predicated on patient selection bias by careful surgeons. Further RCTs are required to obtain more powerful evidence-based data.


DOI: 10.1007/s00268-014-2710-0
PubMed: 25135172


Affiliations:

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Le document en format XML

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<term>Adult (MeSH)</term>
<term>Female (MeSH)</term>
<term>Hernia, Inguinal (complications)</term>
<term>Hernia, Inguinal (surgery)</term>
<term>Humans (MeSH)</term>
<term>Recurrence (MeSH)</term>
<term>Surgical Mesh (MeSH)</term>
<term>Surgical Wound Infection (epidemiology)</term>
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<term>Adulte (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Filet chirurgical (MeSH)</term>
<term>Hernie inguinale (chirurgie)</term>
<term>Hernie inguinale (complications)</term>
<term>Humains (MeSH)</term>
<term>Infection de plaie opératoire (épidémiologie)</term>
<term>Récidive (MeSH)</term>
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<keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr">
<term>Hernie inguinale</term>
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<term>Hernia, Inguinal</term>
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<term>Surgical Wound Infection</term>
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<keywords scheme="MESH" qualifier="surgery" xml:lang="en">
<term>Hernia, Inguinal</term>
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<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND</b>
</p>
<p>The optimal technique to cure strangulated inguinal hernia remains controversial. The use of mesh in cases of strangulated hernia is still debated due to the potential risk of infection.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>OBJECTIVE</b>
</p>
<p>This systematic review aimed to determine whether or not the mesh repair technique is associated with a higher risk of surgical site infection than non-mesh techniques for strangulated inguinal hernias in adults.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>An electronic search of the relevant literature was performed on 15 December 2012 using the following databases: MEDLINE, the Cochrane Library, Scopus, Embase, and the Web of Science. Articles reporting a comparison between the mesh repair technique and a non-mesh technique to treat strangulated inguinal hernias in adults, and published in the English or French language in a peer-reviewed journal, were considered for analysis. The quality of randomized controlled trials (RCTs) was assessed using the Jadad scoring system. To assess the quality of non-randomized trials, we used the Methodological Index for Non-Randomized Studies (MINORS).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>A total of 232 papers was found in the initial search; nine were included in the meta-analysis. The wound infection rate in the mesh repair technique group was lower than in the control group, with a trend towards significance (odds ratio [OR] 0.46, 95 % confidence interval [CI] 0.20-1.07; p = 0.07). The hernia recurrence rate was lower in the mesh repair group (OR 0.2, 95 % CI 0.05-0.78; p = 0.02).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSION</b>
</p>
<p>The mesh repair technique is a good option for the treatment of strangulated inguinal hernias in adults, giving an acceptable wound infection rate and fewer recurrences than non-mesh repair. Our study does not allow us to recommend the use of mesh in cases of bowel resection. We emphasize that, except the two RCTs, the results are predicated on patient selection bias by careful surgeons. Further RCTs are required to obtain more powerful evidence-based data.</p>
</div>
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