Lightweight Versus Heavyweight Mesh In Laparoscopic Totally Extraperitoneal(TEP) Inguinal Hernia Repair: A Meta-analysis

Objective:Inguinal hernia is a kind of common disease.Inguinal hernia repair is one of the most common operation in the department of general surgery.The aim of this meta analysis conducted of randomized controlled trials was to compare lightweight mesh with heavyweight mesh in laparoscopic totally extraperitoneal(TEP) inguinal hernia repair.Methods:Pubmed, Embase, the Cochrane library,CBM,VIP Chinese Scientific Journals database, CNKI and Wanfang data were searched for prospective randomized controlled trials of lightweight versus heavyweight mesh for TEP hernia repair from inception to february 2016.Reference of the included studies were also retrieved.Two reviewers screened the literature according to the inclusion criteria and exclusion criteria and assess the methodological quality of the included studies and extracted relevant data independently.The analysis was performed with Revman5.3 software.Result:Seven trials were included in the meta-analysis of 2377 hernias in 1761 patients. Mean follow-up was between 2 and 24 months.We compared the two meshes in recurrence,chronic pain,foreign body sensation,seroma development and time to return to work.Lightweight mesh was associated with a higher recurrence rate[RD=0.01;95% CI(0.00,0.02);P=0.01].There was no statistically difference in any degree of chronic pain [OR=0.87; 95%CI(0.64,1.18); P=0.36] and no statistically difference in moderate or severe chronic pain[OR=1.69; 95%CI(0.69,4.11)P=0.25] after three months;There was no statistically difference in any degree of chronic pain [OR=0.94; 95%CI(0.36,2.43); P=0.90] and no statistically difference in moderate or severe chronic pain[OR=2.22; 95%CI(0.88,5.60); P=0.09] after 12 months.Lightweight and heavyweight mesh repair had similar outcomes with regard to foreign body sensation[OR=0.64;95%CI(0.16,2.61);P=0.54],seroma development[OR=0.82;95%CI(0.50,1.33); P=0.42] and time to return to work [WMD=-0.31;95%CI(-1.27,0.65);P=0.53].Conclusion:Current evidence suggests that the use of lightweight mesh for TEP repair is associated with an increased risk of hernia recurrence. The two meshes repair have similar outcomes with regard to foreign body sensation, seroma development, and time to return to work.However, considering the limited included studies and possible bias,high-quality RCTs with longer follow-up periods are required to validate these findings.