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Mesh repair for lateral inguinal hernias: a non-evidence-based practice.

D E Tripoloni1, M I Canaro García2, F Cassani2

  • 1División Emergencias, Sanatorio Municipal "Dr. Julio Méndez", Cervantes 362, Buenos Aires, Argentina. dtripoloni@hotmail.com.

Hernia : the Journal of Hernias and Abdominal Wall Surgery
|May 13, 2021
PubMed
Summary

Mesh techniques may not reduce recurrence rates for all primary inguinal hernias (PIH). Patient stratification by hernia type is crucial for accurate comparisons of mesh versus tissue repair, especially for lower-risk lateral hernias.

Keywords:
EvidenceMesh repairTissue repair

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Area of Science:

  • Surgical Oncology
  • Hernia Repair
  • Clinical Evidence Synthesis

Background:

  • Current EHS guidelines advocate mesh for symptomatic primary inguinal hernias (PIH) in adult males.
  • However, the continued use of tissue techniques suggests a need for further investigation into mesh efficacy.
  • Patient stratification by recurrence risk (medial/mixed vs. lateral) may explain disparate trial results.

Purpose of the Study:

  • To evaluate if lack of patient stratification by hernia type impacts conclusions on mesh effectiveness.
  • To identify other methodological limitations in randomized controlled trials (RCTs) comparing mesh and tissue repair for PIH.

Main Methods:

  • Assessed hernia classification, number needed to treat (NNT), and statistical power in RCTs from clinical guidelines.
  • Focused on recurrence rates for PIH after mesh versus non-mesh repair techniques.

Main Results:

  • Most included trials were underpowered.
  • Only five studies classified hernia types.
  • The benefit of mesh techniques for lower-risk lateral hernias (LRRH) and higher-risk hernias (HRRH) was small, with high NNT values for LRRH.

Conclusions:

  • High-level evidence does not support mesh superiority for all PIH.
  • The NNT for pure lateral hernias is substantial, requiring consideration of chronic pain and costs.
  • Stratification by hernia type is essential for accurate assessment of surgical techniques.