Skip to main content

Advertisement

SpringerLink
Log in

Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis

  • Review
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Background

Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair.

Methods

We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics.

Results

1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR − 1.02; 95% CI − 1.87, − 0.17; P = 0.02; I2 = 94%) and operative time (OR − 9.21; 95% CI − 16.82, − 1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%).

Conclusions

Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Kumar D, Wu D, Tan B et al (2022) Emergency groin hernia: outcome after mesh and non‐mesh repair. ANZ J Surg ans.18212. https://doi.org/10.1111/ans.18212

  2. The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. https://doi.org/10.1007/s10029-017-1668-x

    Article  Google Scholar 

  3. Samuel JC, Tyson AF, Mabedi C et al (2014) Development of a ratio of emergent to total hernia repairs as a surgical capacity metric. Int J Surg 12:906–911. https://doi.org/10.1016/j.ijsu.2014.07.019

    Article  PubMed  PubMed Central  Google Scholar 

  4. Alvarez JA, Baldonedo RF, Bear IG et al (2004) Incarcerated groin hernias in adults: presentation and outcome. Hernia 8:121–126. https://doi.org/10.1007/s10029-003-0186-1

    Article  CAS  PubMed  Google Scholar 

  5. Simon KL, Frelich MJ, Gould JC et al (2015) Inpatient outcomes after elective versus nonelective ventral hernia repair. J Surg Res 198:305–310. https://doi.org/10.1016/j.jss.2015.03.073

    Article  PubMed  PubMed Central  Google Scholar 

  6. Köckerling F, Simons MP (2018) Current concepts of inguinal hernia repair. Visc Med 34:145–150. https://doi.org/10.1159/000487278

    Article  PubMed  PubMed Central  Google Scholar 

  7. Venara A, Hubner M, Le Naoures P et al (2014) Surgery for incarcerated hernia: short-term outcome with or without mesh. Langenbecks Arch Surg 399:571–577. https://doi.org/10.1007/s00423-014-1202-x

    Article  CAS  PubMed  Google Scholar 

  8. Elsebae MMA, Nasr M, Said M (2008) Tension-free repair versus Bassini technique for strangulated inguinal hernia: a controlled randomized study. Int J Surg Lond Engl 6:302–305. https://doi.org/10.1016/j.ijsu.2008.04.006

    Article  Google Scholar 

  9. Hentati H, Dougaz W, Dziri C (2014) Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J Surg 38:2784–2790. https://doi.org/10.1007/s00268-014-2710-0

    Article  PubMed  Google Scholar 

  10. Sæter AH, Fonnes S, Rosenberg J, Andresen K (2022) High complication and mortality rates after emergency groin hernia repair: a nationwide register-based cohort study. Hernia J Hernias Abdom Wall Surg 26:1131–1141. https://doi.org/10.1007/s10029-022-02597-8

    Article  Google Scholar 

  11. Sakamoto T, Fujiogi M, Ishimaru M et al (2022) Comparison of postoperative infection after emergency inguinal hernia surgery with enterectomy between mesh repair and non-mesh repair: a national database analysis. Hernia J Hernias Abdom Wall Surg 26:217–223. https://doi.org/10.1007/s10029-021-02439-z

    Article  CAS  Google Scholar 

  12. Duan S-J, Qiu S-B, Ding N-Y et al (2018) Prosthetic mesh repair in the emergency management of acutely strangulated groin hernias with grade I bowel necrosis: a rational choice. Am Surg 84:215–219

    Article  PubMed  Google Scholar 

  13. Karaca A, Karaca S, Capar M et al (2016) Is graft use safe in emergency inguinal hernia repair? J Clin Anal Med 7:236–239. https://doi.org/10.4328/JCAM.3862

    Article  Google Scholar 

  14. Panda N, Ghoshal D, Das S, Das R (2012) Lichtenstein’s mesh versus Bassini tissue repair technique for obstructed inguinal hernia: a controlled randomized study. Eur Surg Acta Chir Austriaca 44:314–318. https://doi.org/10.1007/s10353-012-0151-2

    Article  Google Scholar 

  15. Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  PubMed Central  Google Scholar 

  17. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dai W, Chen Z, Zuo J et al (2019) Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia J Hernias Abdom Wall Surg 23:267–276. https://doi.org/10.1007/s10029-018-1854-5

    Article  CAS  Google Scholar 

  19. Tastaldi L, Krpata DM, Prabhu AS et al (2019) Emergent groin hernia repair: a single center 10-year experience. Surgery 165:398–405. https://doi.org/10.1016/j.surg.2018.08.001

    Article  PubMed  Google Scholar 

  20. Liu J, Chen J, Shen Y (2020) The results of open preperitoneal prosthetic mesh repair for acutely incarcerated or strangulated inguinal hernia: a retrospective study of 146 cases. Surg Endosc 34:47–52. https://doi.org/10.1007/s00464-019-06729-7

    Article  PubMed  Google Scholar 

  21. Chen F, Liu M, Jin C et al (2020) Tension-free mesh repair for incarcerated groin hernia: a comparative study. Surg Innov 27:352–357. https://doi.org/10.1177/1553350620901392

    Article  PubMed  Google Scholar 

  22. Tomaoglu K, Okmen H (2021) Prosthetic mesh hernioplasty versus primary repair in incarcerated and strangulated groin and abdominal wall hernias with or without organ resection. Retrospective study. Langenbecks Arch Surg 406:1651–1657. https://doi.org/10.1007/s00423-021-02145-5

    Article  PubMed  Google Scholar 

  23. Gopal SV, Warrier A (2013) Recurrence after groin hernia repair-revisited. Int J Surg 11:374–377. https://doi.org/10.1016/j.ijsu.2013.03.012

    Article  PubMed  Google Scholar 

  24. Karakose O, Eken H (2016) Shouldice herniorrhaphy—still an effective technique: a retrospective cohort study. Int J Surg Open 3:11–13. https://doi.org/10.1016/j.ijso.2016.04.006

    Article  Google Scholar 

  25. Amato B, Moja L, Panico S et al (2012) Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD001543.pub4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wysocki A, Kulawik J, Poźniczek M, Strzałka M (2006) Is the Lichtenstein operation of strangulated groin hernia a safe procedure? World J Surg 30:2065–2070. https://doi.org/10.1007/s00268-005-0416-z

    Article  PubMed  Google Scholar 

  27. Köckerling F, Heine T, Adolf D et al (2021) Trends in emergent groin hernia repair—an analysis from the herniamed registry. Front Surg 8:655755. https://doi.org/10.3389/fsurg.2021.655755

  28. Kohga A, Kawabe A, Yajima K et al (2020) Emergency surgery versus elective surgery after reduction for patients with incarcerated groin hernias. ANZ J Surg 90:1086–1091. https://doi.org/10.1111/ans.15877

    Article  PubMed  Google Scholar 

  29. Payiziwula J, Zhao P-J, Aierken A et al (2019) Laparoscopy versus open incarcerated inguinal hernia repair in octogenarians: single-center experience with world review. Surg Laparosc Endosc Percutan Tech 29:138–140. https://doi.org/10.1097/SLE.0000000000000629

    Article  PubMed  Google Scholar 

  30. Rodrigues-Gonçalves V, Verdaguer M, Bravo-Salva A et al (2022) Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study. Hernia J Hernias Abdom Wall Surg. https://doi.org/10.1007/s10029-022-02673-z

    Article  Google Scholar 

  31. Tatar C, Tüzün İS, Karşıdağ T et al (2016) Prosthetic mesh repair for incarcerated inguinal hernia. Balk Med J 33:434–440. https://doi.org/10.5152/balkanmedj.2016.150137

    Article  Google Scholar 

  32. Collins MM, Race B, Messer RJ et al (2023) Practical mouse model to investigate therapeutics for Staphylococcus aureus contaminated surgical mesh implants. J Surg Res 283:428–437. https://doi.org/10.1016/j.jss.2022.10.093

    Article  CAS  PubMed  Google Scholar 

  33. Ueda J, Nomura T, Sasaki J et al (2012) Prosthetic repair of an incarcerated groin hernia with small intestinal resection. Surg Today 42:359–362. https://doi.org/10.1007/s00595-011-0019-2

    Article  PubMed  Google Scholar 

  34. Wysocki A, Strzałka M, Migaczewski M, Budzyński P (2014) Short- and long-term outcomes of incarcerated inguinal hernias repaired by Lichtenstein technique. Videosurg Miniinvas Tech 2:196–200. https://doi.org/10.5114/wiitm.2014.41630

    Article  Google Scholar 

  35. Derici H, Unalp HR, Nazli O et al (2010) Prosthetic repair of incarcerated inguinal hernias: is it a reliable method? Langenbecks Arch Surg 395:575–579. https://doi.org/10.1007/s00423-008-0326-2

    Article  PubMed  Google Scholar 

  36. Li J, Qin C, Hu Y (2022) Comparison of mesh repair and suture repair for the treatment of incarcerated femoral hernia: a retrospective, single-center study. Surg Endosc. https://doi.org/10.1007/s00464-022-09488-0

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sharma G, Schouten JA, Itani KMF (2017) Repair of a bowel-containing, scrotal hernia with incarceration contributed by femorofemoral bypass graft. J Surg Case Rep 2017:rjw228. https://doi.org/10.1093/jscr/rjw228

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kurt N, Oncel M, Ozkan Z, Bingul S (2003) Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 27:741–743. https://doi.org/10.1007/s00268-003-6826-x

    Article  PubMed  Google Scholar 

  39. Atila K, Guler S, Inal A et al (2010) Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg 395:563–568. https://doi.org/10.1007/s00423-008-0414-3

    Article  PubMed  Google Scholar 

  40. Oida T, Kawasaki A, Mimatsu K et al (2012) Mesh vs. non-mesh repair for inguinal hernias in emergency operations. Hepatogastroenterology 59:2112–2114

    PubMed  Google Scholar 

  41. Sawayama H, Kanemitsu K, Okuma T et al (2014) Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients. Hernia J Hernias Abdom Wall Surg 18:399–406. https://doi.org/10.1007/s10029-013-1058-y

    Article  CAS  Google Scholar 

  42. Priego P, Lobo E, Moreno I et al (2005) Acute appendicitis in an incarcerated crural hernia: analysis of our experience. Rev Espanola Enfermedades Dig Organo Of Soc Espanola Patol Dig 97:707–715. https://doi.org/10.4321/s1130-01082005001000004

    Article  CAS  Google Scholar 

  43. Wilson RB, Farooque Y (2022) Risks and prevention of surgical site infection after hernia mesh repair and the predictive utility of ACS-NSQIP. J Gastrointest Surg 26:950–964. https://doi.org/10.1007/s11605-022-05248-6

    Article  PubMed  PubMed Central  Google Scholar 

  44. Montgomery A, Kallinowski F, Köckerling F (2016) Evidence for replacement of an infected synthetic by a biological mesh in abdominal wall hernia repair. Front Surg. https://doi.org/10.3389/fsurg.2015.00067

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bueno Lledó J, Sosa Quesada Y, Gavara GI et al (2009) Infección de la prótesis en la reparación herniaria. Nuestra experiencia en 5 años. Cir Esp 85:158–164. https://doi.org/10.1016/j.ciresp.2008.09.008

    Article  PubMed  Google Scholar 

  46. Tolino MJ, Tripoloni DE, Ratto R, García MI (2009) Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results. Hernia 13:631–637. https://doi.org/10.1007/s10029-009-0541-y

    Article  CAS  PubMed  Google Scholar 

  47. Birolini C, de Miranda JS, Utiyama EM, Rasslan S (2015) A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field? Hernia 19:239–246. https://doi.org/10.1007/s10029-014-1225-9

    Article  CAS  PubMed  Google Scholar 

  48. Sartori A, Balla A, Botteri E et al (2022) Laparoscopic approach in emergency for the treatment of acute incarcerated groin hernia: a systematic review and meta-analysis. Hernia. https://doi.org/10.1007/s10029-022-02631-9

    Article  PubMed  Google Scholar 

  49. Kamtoh G, Pach R, Kibil W et al (2014) Effectiveness of mesh hernioplasty in incarcerated inguinal hernias. Wideochirurgia Inne Tech Maloinwazyjne Videosurgery Miniinvasive Tech 9:415–419. https://doi.org/10.5114/wiitm.2014.43080

    Article  Google Scholar 

Download references

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. School of Medicine, Universidade Federal da Fronteira Sul, 20 Capitão Araújo St, Passo Fundo, RS, 99010121, Brazil

    P. Marcolin

  2. Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA

    Sérgio Mazzola Poli de Figueiredo, Rui-Min Diana Mao & R. Lu

  3. School of Medicine, Universidade Salvador, Salvador, BA, Brazil

    Vitor Moura Fé de Melo

  4. Department of Vascular Surgery, Hospital Regional Hans Dieter Schimidt, Joinville, SC, Brazil

    Sérgio Walmir de Araújo

  5. School of Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil

    Marcella Mota Constante

  6. Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA

    A. Villasante-Tezanos

Authors
  1. P. Marcolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sérgio Mazzola Poli de Figueiredo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vitor Moura Fé de Melo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sérgio Walmir de Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcella Mota Constante
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rui-Min Diana Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Villasante-Tezanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Marcolin.

Ethics declarations

Conflict of interest

Patrícia Marcolin, Dr. Sergio Mazzola Poli de Figueiredo, Dr. Sérgio Walmir de Araújo, Marcella Mota Constante, Vítor Moura Fé de Melo, Dr. Rui-Min Diana Mao and Dr. Villasante-Tezanos declare that they have no conflict of interest. Dr. Richard Lu received payment/honoraria for lectures and presentations from Intuitive Surgical that are unrelated to this work.

Ethical approval

For this type of study ethical approval is not required.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marcolin, P., Mazzola Poli de Figueiredo, S., Moura Fé de Melo, V. et al. Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis. Hernia 27, 1397–1413 (2023). https://doi.org/10.1007/s10029-023-02874-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-023-02874-0

Keywords

Search

Navigation