TY - JOUR
T1 - Repair of Groin Hernia with Synthetic Mesh
T2 - Meta-Analysis of Randomized Controlled Trials
AU - The EU Hernia Trialists Collaboration
AU - Grant, Adrian
AU - Go, Peter
AU - Fingerhut, Abe
AU - Kingsnorth, Andrew
AU - Merello, Jesús
AU - O’Dwyer, Paddy
AU - Payne, John
AU - McCormack, Kirsty
AU - Ross, Sue
AU - Scott, Neil
AU - Vale, Luke
AU - Aitola, Petri
AU - Anderberg, Bo
AU - Barkun, Jeffrey
AU - Jnr, Richard Barth
AU - Bay-Nielsen, Morten
AU - Beets, Geerard
AU - Bittner, Reinhard
AU - Bringman, Sven
AU - Callesen, Torben
AU - Castoro, Carlo
AU - Dirksen, Carmen
AU - Filipi, Charles
AU - Fitzgibbons, Robert
AU - Friis, Esbern
AU - Girão, Ricardo
AU - Graham, Paul
AU - Hatzitheoklitos, Efthimios
AU - Hauters, Philippe
AU - Heikkinen, Timo
AU - Jeekel, Hans
AU - Johansson, Bo
AU - Juul, Poul
AU - Kald, Anders
AU - Kehlet, Henrik
AU - Khoury, Najib
AU - Klingler, Anton
AU - Köninger, J.
AU - Kozol, Robert
AU - Leibl, Bernhard
AU - Macintyre, Ian
AU - Maddern, Guy
AU - McGillicuddy, James
AU - Millat, Bertrand
AU - Nilsson, Erik
AU - Nordin, Pär
AU - Paganini, Alessandro
AU - Pappalardo, Giuseppe
AU - Pedrós, Joan Sala
AU - Sarli, Leopoldo
PY - 2002
Y1 - 2002
N2 - Objective: To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair. Summary Background Data: Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain. Methods: Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat. Results: There were 62 relevant comparisons in 58 trials. These included 11,174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% Cl 0.34-0.55; P < .001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% Cl 0.29-0.46; P < .001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% Cl 0.76-2.08; P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% Cl 0.52-0.78; P < .001). Conclusions: The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method. Mesh repair appears to reduce the chance of persisting pain rather than increase it.
AB - Objective: To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair. Summary Background Data: Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain. Methods: Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat. Results: There were 62 relevant comparisons in 58 trials. These included 11,174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% Cl 0.34-0.55; P < .001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% Cl 0.29-0.46; P < .001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% Cl 0.76-2.08; P = .36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% Cl 0.52-0.78; P < .001). Conclusions: The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method. Mesh repair appears to reduce the chance of persisting pain rather than increase it.
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U2 - 10.1097/00000658-200203000-00003
DO - 10.1097/00000658-200203000-00003
M3 - Review article
C2 - 11882753
AN - SCOPUS:0036189201
VL - 235
SP - 322
EP - 332
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 3
ER -