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

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.