World Journal of Surgery

, Volume 43, Issue 2, pp 447–456 | Cite as

Open Inguinal Hernia Repair: A Network Meta-analysis Comparing Self-Gripping Mesh, Suture Fixation, and Glue Fixation

  • Emanuele RausaEmail author
  • Emanuele Asti
  • Michael Eamon Kelly
  • Alberto Aiolfi
  • Andrea Lovece
  • Gianluca Bonitta
  • Luigi Bonavina
Scientific Review


The most troublesome complications of inguinal hernia repair are recurrent herniation and chronic pain. A multitude of technological products dedicated to abdominal wall surgery, such as self-gripping mesh (SGM) and glue fixation (GF), were introduced in alternative to suture fixation (SF) in the attempt to lower the postoperative complication rates. We conducted an electronic systematic search using MEDLINE databases that compared postoperative pain and short- and long-term surgical complications after SGM or GF and SF in open inguinal hernia repair. Twenty-eight randomized controlled trials totaling 5495 patients met the inclusion criteria and were included in this network meta-analysis. SGM and GF did not show better outcomes in either short- or long-term complications compared to SF. Patients in the SGM group showed significantly more pain at day 1 compared to those in the GF group (VAS score pain mean difference: − 5.2 Crl − 11.0; − 1.2). The relative risk (RR) of developing a surgical site infection (RR 0.83; Crl 0.50–1.32), hematoma (RR 1.9; Crl 0.35–11.2), and seroma (RR 1.81; Crl 0.54–6.53) was similar in SGM and GF groups. Both the SGM and GF had a significantly shorter operative time mean difference (1.70; Crl − 1.80; 5.3) compared to SF. Chronic pain and hernia recurrence did not statistically differ at 1 year (RR 0.63; Crl 0.36–1.12; RR 1.5; Crl 0.52–4.71, respectively) between SGM and GF. Methods of inguinal hernia repair are evolving, but there remains no superiority in terms of mesh fixation. Ultimately, patient’s preference and surgeon’s expertise should still lead the choice about the fixation method.

Supplementary material

268_2018_4807_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 kb)
268_2018_4807_MOESM2_ESM.docx (19 kb)
Supplementary material 2 (DOCX 19 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Division of General SurgeryIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  2. 2.Department of Biomedical Sciences of HealthUniversity of Milan Medical SchoolSan Donato MilaneseItaly
  3. 3.Department of Colorectal SurgeryConnolly HospitalDublinIreland

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