No mesh fixation versus mesh fixation in laparoscopic groin hernia repair

This Cochrane protocol aims to determine whether fixating the mesh during laparoscopic groin hernia repair—using either penetrating (tacks, staples, sutures) or non-penetrating (glue, self-gripping mesh) methods—is superior to using no fixation at all. While laparoscopic repair is standard for elective groin hernia surgery, there is no consensus on whether mesh fixation is necessary. The authors hypothesize that while fixation might prevent mesh migration and recurrence, it could also increase the risk of postoperative complications such as acute and chronic pain, haematoma, and vascular injury.

The review will include only randomized controlled trials (RCTs) comparing no mesh fixation to any mesh fixation technique in adult patients undergoing elective laparoscopic groin hernia repair. The authors will perform a comprehensive search of major databases (Embase, MEDLINE, CENTRAL) and trial registries. Data will be synthesized using a random-effects model, and the certainty of the evidence will be assessed using the GRADE approach. The primary outcomes of interest are chronic pain (at least six months postoperatively) and hernia recurrence (at least 12 months postoperatively).

Postoperative complications, particularly chronic pain, significantly impact patient quality of life following hernia surgery. Previous systematic reviews have largely focused on the total extraperitoneal (TEP) repair technique and often suffered from insufficient follow-up times. By including both TEP and transabdominal preperitoneal (TAPP) repairs and applying rigorous Cochrane methodology, this review will provide evidence-based guidance for surgeons and patients. If no fixation proves to be as safe and effective as fixation, it could reduce surgical trauma and lower costs associated with fixation materials.