Tension-Free Hernioplasty for Groin Hernia in Adult:A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Jianping , LIU Qi

Department of Geriatric Surgery, The second Affiliated Hospital, Xiangya Medical Collage, Central South University, Changsha 410011, China;

Corresponding author：

Keywords：

Tension-free hernioplasty, Meta-analysis

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Objective 　To evaluate the effectiveness of inguinal hernia treated by tension-free hernioplasty in adult.
Methods 　Electronic databases were searched including CNKI (1993 to 2003), MEDLINE (1993 to 2003) and OVID (1993 to 2003). Personal contact with experts in the field of tension-free hernioplasty was performed to identify potentially relevant trials. Randomized controlled trials of plug amp; Mesh versus Mesh only repair and laparoscopic versus open Mesh hernia repair in recurrence, peri-operative complication or long term postoperative complication were included. Data related to the clinical outcome were extracted by two reviewers independently. Statistical analysis was performed by using RevMan 4.2 software.
Results 　Twenty one studies involving 4 154 patients met the inclusion criteria from 1993 to 2003. Compared with Mesh only repair, plug amp; Mesh repair had no significant difference in recurrence rate (OR 1.14, 95%CI 0.37 to 3.47, P=0.82), preoperative complication rate (OR 1.01, 95%CI 0.63 to 1.63, P=0.95) and long term postoperative complication rate (OR 0.46, 95%CI 0.18 to 1.16, P=0.1). Compared with open Mesh hernioplasty, transabdominal preperitoreal repair (TAPP) group had no significant difference in recurrence rate (OR1.24, 95%CI 0.65 to 2.36, P=0.52), preoperative complication rate (OR 0.89, 95%CI 0.65 to 1.22, P=0.46) and persistent pain (OR 0.76, 95%CI 0.48 to 1.19, P=0.22); totally extrapevitoreal repair (TEP) group had no significant difference in recurrence rate (OR1.07, 95%CI 0.51 to 2.24, P=0.70) or persistent pain (OR 0.95, 95%CI 0.55 to 1.65, P=0.86), and had lower tendency persistent pain (OR 0.50, 95%CI 0.34 to 0.73, P=0.000 4) with statistical significance.
Conclusion 　Current evidence suggests that there is no significant difference between anterior approach plug amp; Mesh repair (Rutkow’s repair) and the Mesh only repair (Lichtenstein’s repair). TEP of Laparoscopic hernioplasty is superior to open Mesh hernia repair in preoperative complication. More researches are needed for recurrence rate, persistent pain.

Citation： ZHOU Jianping,LIU Qi. Tension-Free Hernioplasty for Groin Hernia in Adult:A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2005, 05(4): 303-310. doi: Copy

1.	方仲雄,唐健雄,陈革,黄磊,周轶群,王巍,戴松林.疝环充填式与平片无张力疝修补术在治疗老年腹股沟疝中的比较[J]老年医学与保健,2001;7(2):75～76.
2.	龙延滨,邱健,杨德庆,王小强,李国威.疝环充填式与平片式无张力疝修补术治疗腹股沟疝的临床比较研究[J]外科理论与实践,2002;7(6):454～458.
3.	王坚,吴志勇.疝环充填式与平片无张力疝修补近期随访研究[J]外科理论与实践,2002;7(6):448～450.
4.	李晋忠,孙立中,刘京山,赵期康两种无张力疝修补术185例临床分析[J]中国冶金工业医学杂志,2002;19(2):98～99.
5.	周建平,李铁钢,范丹凤.Prolene网片在成人腹股沟疝前路修补中的应用[J].中国普通外科杂志,2002;11(8):499～500.
6.	周建平,李铁钢,余丹,姚宏亮,范丹凤.181例腹股沟疝普理灵网片前路修补经验[J]外科理论与实践,2002;7(6):440～442.
7.	杨峰,莫立显,石大洋,陈茂荣腹股沟疝无张力修补的术式选择[J].腹部外科,2003;16(4):241 242.
8.	Clarke M, Oxman AD, editors. Cochrane Reviews’ Handbook 4.0[ updated July 1999 ]; Section 6. In: The Cochrane Library[ database on CD-ROM ]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issue1.
9.	Aldeson P,Green S, Higgins JPT editors. Cochrane Reviews’ Handbook 4.2.2[ Updated December 2003] [M/CD]. In: The Cochrane Library, Issue 1,2004. Chichester,UK:John Wiley & Sons, Ltd.
10.	Fang ZX, Tang JX, Chen G, Huang L, Zhou YQ, Wang W, Dai SL. Comparative study of plug&nesh and only patch tension free hernioplasty in treating the groin herrna in elderly [J]. Geriatric Health Care, 2001; 7(2): 75-76.
11.	Long YB, Qiu J, Yang DQ, Wang XQ, Li GW. A clinical study on mesh plug and only mesh hernioplasty [J]. Surgical Concepts and Practices, 2002, 7(6): 454 - 458.
12.	Wang J, Wu ZY. A follow-up study on groin hernias treated by the use ofplug&nesh and mesh only[J]. Surgical Concepts and Practices,2002; 7(6): 448 - 450.
13.	Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B,Anderberg B. Tension-free inguinal hernia repair: TEP versus meshplug versus Lichtenstein: a prospective randomized controlled trial [J]. Ann Surg. , 2003; 237(1): 142 -147.
14.	Li JZ, Sun LZ, Liu JS, Zhao QK. A clinical study of two kinds of tension free hernioplasty about 185 cases report[J]. Chinese Medical Journal of Metallurgical Industry, 2002; 19(2): 98 - 99.
15.	Sarli L, Pietra N, Choua O, Costi R, Thenasseril B, Giunta A. Prospective randomised comparative study oflaparoscopic hernioplasty and Lichtenstein tension-free hernioplasty (Italian) [J ]. Acta Biomed Ateneo Parmense, 1997; 68(1 -2) :5 -10.
16.	Paganini AM, Lezoche E, Carle F, Carlei F, Favretti F, Feliciotti F,Gesuita R, Guerrieri M, Lomanto D, Nardovino M, Panti M,Ribichini P, Sarli L, Sottili M, Tamburini A, Taschieri A. A randomized, controlled, clinical study of laparoscopic vs open tensionfree hernia repair[J]. Surg Endosc,1998; 12(7): 979 - 986.
17.	Heikkinen T, Haukipuro K, Hnlkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit[J]. SurgEndosc, 1998; 12(10): 1 199-1 203.
18.	Aitola P, Airo I, Matikainen M. Laparoscopic versus open preperitoheal inguinal hernia repair: A prospective randomised trial [J]. Ann Chir, 1998; 87(1): 22-25.
19.	Koninger JS, Oster M, Butters M. Management of inguinal hernia: a comparison of current methods (German) [J]. Chirurg, 1998; 69(12): 1340-1344.
20.	Zieren J, Zieren HU, Said S, Wenger FA, Muller JM. Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’ s operation [J]. Am J Surg, 1998;175(4): 330-333.
21.	Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G. Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial[J]. Surg Endosc, 1999; 13(4): 323 - 327.
22.	Johansson B, Hallerbaock B, Glise H, Anesten B, Smedberg S, Roman J. Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair. A randomized multicenter trial (SCUR hernia repair study) [J]. Ann Surg, 1999; 230(2): 225-231.
23.	Sarli L, Iusco DR, Sansebastiano G, Costi R. Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open,tension-free versus laparoscopic approach [J]. Surgical Laparoscopy,Endoscopy&Percutaneous Techniques, 2001; 11 (4): 262 - 267.
24.	Payne J, Izawa M, Glen P, Grininger L, Podoll E, Balfour J. Laparoscopic or tension-free inguinal hernia repair.? A cost benefit analysis of 200 prospective randomized patients [Z]. In: SAGES, Philadelphia, Pennsylvania: 1996.
25.	Champault GG, Rizk N, CathelineJM, Turner R, Boutelier P. Inguinal hernia repair. Totally preperitoneal laparoscopic approach versus Stoppa operation: Randomized trial of 100 cases [J]. Surg Laparosc Endosc,1997; 7(6): 445 -450.
26.	Bostanci BE, Tetik C, Ozer S, Ozden A. Posterior approaches in groin hernia repair with prosthesis: open or closed [J]. Acta Chir Belg,1998; 98(6): 241-244.
27.	Khoury N. A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: A study of 315 cases [J]. Journal of Laparoendoscopic&Advanced Surgica Techniques,1998; 8(6): 367-372.
28.	Wright D, Paterson C, Scott N, Hair A, Patrick J. Five-year followup of patients undergoing laparoscopic or open groin hernia repair, a randomized controlled trial [J]. Annals of Surgery, 2002; 235 (3):333-337.
29.	Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic lotally extraperitoneal approach with open mesh repair in inguinal hernia[J]. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2003; 13(3): 191-195.
30.	The MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic versus open repair of groin hernia: a randomized comparison[J]. Lancet,1999; 354(7): 185-190.
31.	Rutkow IM, R obbins AW. "Tension-free" inguinal herniorrhaphy:a preliminary report on the "mesh plug" technique [J]. Surgery,1993, 114(1): 3-8.
32.	Lichtenstein IL,Am id PK, Shulman AG, Montllor MM. The tension-free hernioplasty[J]. Am J Surg, 1989; 157(2): 188-193.
33.	Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992; 35(2): 209-212.
34.	McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg Endosc. 1993;7(1): 26-28.
35.	Zhou JP, Li TG, Fan DF. The appliance ofprolene mesh in adult inguinal hernia anterior approach repair [J]. Chinese General Surgery,2002; 11 (8): 499 - 500.
36.	Zhou JP, Li TG, Yu D, Yao HL, Fan DF. Experience in 181 cases of hernioplasty with prolene mesh [J]. Surgical Concepts and Practices, 2002; 7 (6): 440 - 442.
37.	The EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh, Meta-analysis of randomized controlled trials[J]. Ann Surg, 2002; 235 (3): 322 - 332.
38.	Hung L, Nivritti GP, Francis CWL. Systematic review and rmcta-analysis of clinical trials comparing endoscopic totally extraperitoneal inguinal hernioplasty with open repair of inguinal hernia[J]. Ann. Coll.Surg. H.K, 2003; 7(1): 2-10.
39.	Yang F, Mo LX, Shi DY, Chen MR. The choice of surgical style of tension free repair of inguinal hernia[J]. Abdominal Surgery, 2003;16(4): 241 -242.

1. 方仲雄,唐健雄,陈革,黄磊,周轶群,王巍,戴松林.疝环充填式与平片无张力疝修补术在治疗老年腹股沟疝中的比较[J]老年医学与保健,2001;7(2):75～76.
2. 龙延滨,邱健,杨德庆,王小强,李国威.疝环充填式与平片式无张力疝修补术治疗腹股沟疝的临床比较研究[J]外科理论与实践,2002;7(6):454～458.
3. 王坚,吴志勇.疝环充填式与平片无张力疝修补近期随访研究[J]外科理论与实践,2002;7(6):448～450.
4. 李晋忠,孙立中,刘京山,赵期康两种无张力疝修补术185例临床分析[J]中国冶金工业医学杂志,2002;19(2):98～99.
5. 周建平,李铁钢,范丹凤.Prolene网片在成人腹股沟疝前路修补中的应用[J].中国普通外科杂志,2002;11(8):499～500.
6. 周建平,李铁钢,余丹,姚宏亮,范丹凤.181例腹股沟疝普理灵网片前路修补经验[J]外科理论与实践,2002;7(6):440～442.
7. 杨峰,莫立显,石大洋,陈茂荣腹股沟疝无张力修补的术式选择[J].腹部外科,2003;16(4):241 242.
8. Clarke M, Oxman AD, editors. Cochrane Reviews’ Handbook 4.0[ updated July 1999 ]; Section 6. In: The Cochrane Library[ database on CD-ROM ]. The Cochrane Collaboration. Oxford: Update Software; 2000, Issue1.
9. Aldeson P,Green S, Higgins JPT editors. Cochrane Reviews’ Handbook 4.2.2[ Updated December 2003] [M/CD]. In: The Cochrane Library, Issue 1,2004. Chichester,UK:John Wiley & Sons, Ltd.
10. Fang ZX, Tang JX, Chen G, Huang L, Zhou YQ, Wang W, Dai SL. Comparative study of plug&nesh and only patch tension free hernioplasty in treating the groin herrna in elderly [J]. Geriatric Health Care, 2001; 7(2): 75-76.
11. Long YB, Qiu J, Yang DQ, Wang XQ, Li GW. A clinical study on mesh plug and only mesh hernioplasty [J]. Surgical Concepts and Practices, 2002, 7(6): 454 - 458.
12. Wang J, Wu ZY. A follow-up study on groin hernias treated by the use ofplug&nesh and mesh only[J]. Surgical Concepts and Practices,2002; 7(6): 448 - 450.
13. Bringman S, Ramel S, Heikkinen TJ, Englund T, Westman B,Anderberg B. Tension-free inguinal hernia repair: TEP versus meshplug versus Lichtenstein: a prospective randomized controlled trial [J]. Ann Surg. , 2003; 237(1): 142 -147.
14. Li JZ, Sun LZ, Liu JS, Zhao QK. A clinical study of two kinds of tension free hernioplasty about 185 cases report[J]. Chinese Medical Journal of Metallurgical Industry, 2002; 19(2): 98 - 99.
15. Sarli L, Pietra N, Choua O, Costi R, Thenasseril B, Giunta A. Prospective randomised comparative study oflaparoscopic hernioplasty and Lichtenstein tension-free hernioplasty (Italian) [J ]. Acta Biomed Ateneo Parmense, 1997; 68(1 -2) :5 -10.
16. Paganini AM, Lezoche E, Carle F, Carlei F, Favretti F, Feliciotti F,Gesuita R, Guerrieri M, Lomanto D, Nardovino M, Panti M,Ribichini P, Sarli L, Sottili M, Tamburini A, Taschieri A. A randomized, controlled, clinical study of laparoscopic vs open tensionfree hernia repair[J]. Surg Endosc,1998; 12(7): 979 - 986.
17. Heikkinen T, Haukipuro K, Hnlkko A. A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit[J]. SurgEndosc, 1998; 12(10): 1 199-1 203.
18. Aitola P, Airo I, Matikainen M. Laparoscopic versus open preperitoheal inguinal hernia repair: A prospective randomised trial [J]. Ann Chir, 1998; 87(1): 22-25.
19. Koninger JS, Oster M, Butters M. Management of inguinal hernia: a comparison of current methods (German) [J]. Chirurg, 1998; 69(12): 1340-1344.
20. Zieren J, Zieren HU, Said S, Wenger FA, Muller JM. Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’ s operation [J]. Am J Surg, 1998;175(4): 330-333.
21. Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G. Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial[J]. Surg Endosc, 1999; 13(4): 323 - 327.
22. Johansson B, Hallerbaock B, Glise H, Anesten B, Smedberg S, Roman J. Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair. A randomized multicenter trial (SCUR hernia repair study) [J]. Ann Surg, 1999; 230(2): 225-231.
23. Sarli L, Iusco DR, Sansebastiano G, Costi R. Simultaneous repair of bilateral inguinal hernias: a prospective, randomized study of open,tension-free versus laparoscopic approach [J]. Surgical Laparoscopy,Endoscopy&Percutaneous Techniques, 2001; 11 (4): 262 - 267.
24. Payne J, Izawa M, Glen P, Grininger L, Podoll E, Balfour J. Laparoscopic or tension-free inguinal hernia repair.? A cost benefit analysis of 200 prospective randomized patients [Z]. In: SAGES, Philadelphia, Pennsylvania: 1996.
25. Champault GG, Rizk N, CathelineJM, Turner R, Boutelier P. Inguinal hernia repair. Totally preperitoneal laparoscopic approach versus Stoppa operation: Randomized trial of 100 cases [J]. Surg Laparosc Endosc,1997; 7(6): 445 -450.
26. Bostanci BE, Tetik C, Ozer S, Ozden A. Posterior approaches in groin hernia repair with prosthesis: open or closed [J]. Acta Chir Belg,1998; 98(6): 241-244.
27. Khoury N. A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: A study of 315 cases [J]. Journal of Laparoendoscopic&Advanced Surgica Techniques,1998; 8(6): 367-372.
28. Wright D, Paterson C, Scott N, Hair A, Patrick J. Five-year followup of patients undergoing laparoscopic or open groin hernia repair, a randomized controlled trial [J]. Annals of Surgery, 2002; 235 (3):333-337.
29. Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic lotally extraperitoneal approach with open mesh repair in inguinal hernia[J]. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2003; 13(3): 191-195.
30. The MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic versus open repair of groin hernia: a randomized comparison[J]. Lancet,1999; 354(7): 185-190.
31. Rutkow IM, R obbins AW. "Tension-free" inguinal herniorrhaphy:a preliminary report on the "mesh plug" technique [J]. Surgery,1993, 114(1): 3-8.
32. Lichtenstein IL,Am id PK, Shulman AG, Montllor MM. The tension-free hernioplasty[J]. Am J Surg, 1989; 157(2): 188-193.
33. Dion YM, Morin J. Laparoscopic inguinal herniorrhaphy[J]. Can J Surg, 1992; 35(2): 209-212.
34. McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg Endosc. 1993;7(1): 26-28.
35. Zhou JP, Li TG, Fan DF. The appliance ofprolene mesh in adult inguinal hernia anterior approach repair [J]. Chinese General Surgery,2002; 11 (8): 499 - 500.
36. Zhou JP, Li TG, Yu D, Yao HL, Fan DF. Experience in 181 cases of hernioplasty with prolene mesh [J]. Surgical Concepts and Practices, 2002; 7 (6): 440 - 442.
37. The EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh, Meta-analysis of randomized controlled trials[J]. Ann Surg, 2002; 235 (3): 322 - 332.
38. Hung L, Nivritti GP, Francis CWL. Systematic review and rmcta-analysis of clinical trials comparing endoscopic totally extraperitoneal inguinal hernioplasty with open repair of inguinal hernia[J]. Ann. Coll.Surg. H.K, 2003; 7(1): 2-10.
39. Yang F, Mo LX, Shi DY, Chen MR. The choice of surgical style of tension free repair of inguinal hernia[J]. Abdominal Surgery, 2003;16(4): 241 -242.

Chinese Journal of Evidence-Based Medicine

Tension-Free Hernioplasty for Groin Hernia in Adult:A Meta-Analysis

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