TY - JOUR
T1 - Chronic pain after mesh versus nonmesh repair of inguinal hernias
T2 - A systematic review and a network meta-analysis of randomized controlled trials
AU - Öberg, Stina
AU - Andresen, Kristoffer
AU - Klausen, Tobias W
AU - Rosenberg, Jacob
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2018/5
Y1 - 2018/5
N2 - BACKGROUND: Chronic pain affects 10%-12% of patients after inguinal hernia repairs. Some have suggested that less foreign material may theoretically prevent pain. If the prevalence of chronic pain is less after nonmesh repairs, selected hernias might be repaired without mesh. Our aim was to clarify if nonmesh repairs are superior to mesh repairs regarding chronic pain.METHODS: For this systematic review, searches were conducted in five databases. The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. Only randomized controlled trials (RCTs) were included.RESULTS: A total of 23 RCTs with 5,444 patients were included. The median follow up was 1.4 years (range 0.5-10). Twenty-one studies reported crude chronic pain rates, and when considering moderate and severe pain, the prevalences of pain after nonmesh repairs and mesh repairs were similar: median 3.5% (0%-16.2%) versus median 2.9% (0%-27.6%), respectively. Both the meta-analyses and the network meta-analysis indicated no difference in chronic pain rates when comparing nonmesh repairs with open- and laparoscopic mesh repairs.CONCLUSION: Mesh may be used without fear of causing a greater rate of chronic pain.
AB - BACKGROUND: Chronic pain affects 10%-12% of patients after inguinal hernia repairs. Some have suggested that less foreign material may theoretically prevent pain. If the prevalence of chronic pain is less after nonmesh repairs, selected hernias might be repaired without mesh. Our aim was to clarify if nonmesh repairs are superior to mesh repairs regarding chronic pain.METHODS: For this systematic review, searches were conducted in five databases. The main outcome was chronic pain reported a minimum of six months after mesh and nonmesh repair in adult patients with a primary inguinal hernia. Only randomized controlled trials (RCTs) were included.RESULTS: A total of 23 RCTs with 5,444 patients were included. The median follow up was 1.4 years (range 0.5-10). Twenty-one studies reported crude chronic pain rates, and when considering moderate and severe pain, the prevalences of pain after nonmesh repairs and mesh repairs were similar: median 3.5% (0%-16.2%) versus median 2.9% (0%-27.6%), respectively. Both the meta-analyses and the network meta-analysis indicated no difference in chronic pain rates when comparing nonmesh repairs with open- and laparoscopic mesh repairs.CONCLUSION: Mesh may be used without fear of causing a greater rate of chronic pain.
KW - Chronic Pain/etiology
KW - Hernia, Inguinal/surgery
KW - Herniorrhaphy/adverse effects
KW - Humans
KW - Postoperative Complications/etiology
KW - Randomized Controlled Trials as Topic
KW - Surgical Mesh/adverse effects
U2 - 10.1016/j.surg.2017.12.017
DO - 10.1016/j.surg.2017.12.017
M3 - Review
C2 - 29506882
SN - 0039-6060
VL - 163
SP - 1151
EP - 1159
JO - Surgery
JF - Surgery
IS - 5
ER -