Mesh Repair Versus No-Mesh Repair for the Management of Acute and Elective Femoral Hernias: A Systematic Review and Meta-Analysis of Perioperative Outcomes.

Abstract

The objective of this meta-analysis was to compare mesh repair versus no-mesh repair in the management of acute and elective femoral hernia repair. Different studies comparing mesh repair versus no-mesh repair in the management of femoral hernia were selected from medical electronic databases, and a meta-analysis was conducted in accordance with the Cochrane Collaboration guidelines using statistical software RevMan version 5.4 (The Cochrane Collaboration, London, UK). Four retrospective studies and one prospective study were included, involving 537 patients, reporting the incidence of recurrence, surgical site infection, complications, and length of hospital stay. In the random effects model analysis, the length of hospital stay was lower in the mesh group but with significant statistical heterogeneity (standardized mean difference (SMD) -0.34, 95% CI (-1.78, -1.11), Z = 0.46, P = 0.65). However, the variables of hernia recurrence, surgical site infection, and total complications were in favor of the mesh group, despite no statistically significant difference between both groups and without any statistical heterogeneity among the included studies: (risk ratio (RR) 0.50, 95% CI (0.25, 1.02), Z = 1.91, P = 0.06); (RR 0.95, 95% CI (0.35, 2.57), Z = 0.10, P = 0.92); (RR 0.99, 95% CI (0.56, 1.74), Z = 0.05, P = 0.96). This systematic review indicates that mesh repair of the femoral hernia does not offer any advantage over no-mesh repair for recurrence. Due to the paucity of randomized clinical trials and significant heterogeneity among the compared variables, a major multicenter randomized clinical trial is needed to validate these findings.