• Mokhtar Eltair, Shahin Hajibandeh, Shahab Hajibandeh, Sankar Balakrishnan, Ahmad Alyamani, Daniel Radoi, Yan Li Goh, Mohamed Hanif, Yogesh Kumar, and Dham Mobarak.
• Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. Electronic address: mokhtair@hotmail.com.
• Int J Surg. 2019 Nov 1; 71: 190-199.

ObjectivesTo evaluate comparative outcomes of laparoscopic repair of groin hernia with and without mesh fixation.MethodsMEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists were systematically checked. Combination of free text and controlled vocabulary search adapted were applied to thesaurus headings, search operators and limits in each of the above databases. Post-operative pain, procedure time, conversion rate, length of hospital stay, time taken to normal activities, overall complications, seroma formation, cost and recurrence were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. The work has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42019139564).ResultsWe identified 13 randomized controlled trials reporting a total of 1731 patients (2021 groin hernia) evaluating outcomes of laparoscopic hernia repair with mesh fixation using stapler or tacker (n = 853 patients, 999 hernia) and without mesh fixation (n = 878 patients, 1022 hernia). Mesh Fixation was associated with significantly higher post-operative pain assessed by visual analogue scale (VAS) (MD: 0.59; 95% CI, 0.05-1.13, P = 0.03) and longer procedure time (MD: 2.00; 95% CI, 0.98-3.02, P = 0.0001), compared to no fixation technique. However, there was no significant difference in length of hospital stay (MD:0.09; 95% CI, -0.05-0.23, P = 0.19), time to normal activities, (MD: 0.12; 95% CI, -0.37-0.61, P = 0.69), overall complications (OR: 1.05; 95% CI, 0.77-1.43, P = 0.76), seroma formation (OR: 0.63; 95% CI, 0.39-1.00, P = 0.05) and recurrence rate (RD: 0.00; 95% CI, -0.01-0.01, P = 0.84) between two groups.ConclusionsAvoiding mesh fixation with a stapler or tacker during laparoscopic groin hernia repair may reduce postoperative pain and procedure time. Future studies are encouraged to evaluate cost effectiveness of each approach.Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.

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