Suture versus tacks in minimally invasive transabdominal preperitoneal inguinal repair: a meta-analysis of randomized controlled trials.

Autor: Pompeu BF; Department of Surgery, Heliopolis Hospital, São Paulo, Brazil. bernardo.pompeu@online.uscs.edu.br.; USCS-Universidade Municipal de São Caetano do Sul, Rua Santo Antônio, 50-Centro, São Caetano do Sul, SP, 09521-160, Brazil. bernardo.pompeu@online.uscs.edu.br., Almiron da Rocha Soares G; Universidade Metropolitana de Santos, Santos, Brazil., Pereira Silva M; Escola Bahiana de Medicina e Saúde Pública, Brotas, Brazil., Ponte Farias AG; Universidade Federal do Ceará, Fortaleza, Brazil., Oliveira de Sousa Silva R; Universidade Federal do Piauí, Teresina, Brazil., Mazzola Poli de Figueiredo S; Department of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Sep; Vol. 38 (9), pp. 4858-4868. Date of Electronic Publication: 2024 Aug 19.
DOI: 10.1007/s00464-024-11138-6
Abstrakt: Introduction: There is uncertainty regarding the method of mesh fixation and peritoneal closure during transabdominal preperitoneal (TAPP) repair for inguinal hernias, with no definitive guidelines to guide surgeon choice.
Methods: MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science were searched for RCTs published until November 2023. Risk ratios (RRs) and mean differences (MD) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I 2 statistics, with p values inferior to 0.10 and I 2  > 25% considered significant. Statistical analyses were conducted using Review Manager version 5.4 and RStudio version 4.1.2 (R Foundation for Statistical Computing).
Results: Eight randomized controlled trials (RCTs) were included, comprising 624 patients, of whom 309 (49.5%) patients were submitted to TAPP with the use of tacks, and 315 (50.5%) received suture fixation. The use of tacker fixation was associated with a significant increase in postoperative pain at 24 h (MD 0.79 [VAS score]; 95% CI 0.38 to 1.19; p < 0.0002; I 2  = 87%) and one week (MD 0.42 [VAS score]; 95% CI 0.05 to 0.79; p < 0.03, I 2  = 84%). The use of tacks was associated with shorter operative time (MD-25.80 [min]; 95% - 34.31- - 17.28; P < 0.00001; I 2  = 94%). No significant differences were found in overall complications, chronic pain, seromas, hematomas, and urinary retention rates.
Conclusion: In patients who underwent TAPP hernia repair, tacks are associated with decreased operative time but increased postoperative pain at 24 h and one week.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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