Meta-analysis of Lichtenstein repair and mesh-plug repair for primary inguinal hernia

Objective To systematically evaluate the application effect of tension-free hernia repair with Lichtenstein and Mesh-plug in the treatment of primary inguinal hernia. Methods The inclusion and exclusion criteria were set up. We searched related domestic and foreign databases, and the retrieval period was from January 2000 to June 2019. Combined with the references found in the literature, we selected the clinical randomized controlled trial on the treatment of primary inguinal hernia by Lichtenstein hernia repair and Mesh-plug hernia repair. The Quality assessment and data extraction were conducted by the two authors respectively. Outcome indicators included postoperative recurrence, mesh cost, hematoma and seroma, discomfort, infection, and pain in the inguinal area. Meta-analysis was conducted after the final included literature data were sorted out. Results A total of 10 RCT studies were included in the analysis, including 1,472 cases in the Lichtenstein group and 1,457 cases in the Mesh-plug group. Meta-analysis results showed that Lichtenstein hernia repair was better than Mesh-plug hernia repair in reducing the incidence of hematoma and seroma after operation [RR=1.45, 95% CI (1.02, 2.06), P=0.04] and reducing the operation cost [WMD=155.15, 95% CI (112.78, 197.53), P<0.000 01], but Lichtenstein hernia repair had a slightly longer operation time [WMD=-7.51, 95% CI (-11.33, -3.68), P=0.0001]. There was no significant difference in postoperative inguinal discomfort, infection, postoperative recurrence, early pain score or incidence of chronic pain. Conclusion Lichtenstein hernia repair has certain advantages in reducing the incidence of postoperative seroma and the operation cost compared with Mesh-plug hernia repair, but the operation time of Lichtenstein is longer. It is suggested that the Lichtenstein hernia repair should be preferred for Mesh-plug hernia repair in the clinical. Key words: Hernia, inguinal; Lichtenstein; Mesh-plug; Tension-free hernia repair; Complications; Meta-analysis