Baker JJ, et al. - Researchers performed a systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair. Here, fixation with sutures during laparoscopic ventral hernia repair was favored by both crude recurrence rates and the network meta-analysis.

Methods

• Researchers performed a systematic review of studies with human adults with a ventral hernia repaired with an intraperitoneal onlay mesh.
• Recurrence at least 6 months after operation was assessed as the outcome measure.
• They included cohort studies with 50 or more participants and all RCTs.
• They searched PubMed, Embase and the Cochrane Library on 22 September 2016.
• With the Cochrane risk-of-bias assessment tool, RCTs were assessed and with the Newcastle–Ottawa scale, cohort studies were assessed.
• In a network meta-analysis, they included studies comparing fixation techniques, which allowed comparison of more than two fixation techniques.

Results

• Researchers included 51 studies with a total of 6,553 participants.
• With the various fixation techniques, the overall crude recurrence rates were: absorbable tacks, 17·5 per cent (2 treatment groups); absorbable tacks with sutures, 0·7 per cent (3); permanent tacks, 7·7 per cent (20); permanent tacks with sutures, 6·0 per cent (25); and sutures, 1·5 per cent (6).
• In a network meta-analysis, they included 6 studies, which favoured fixation with sutures.
• Despite not achieving statistical significance, there was a 93% chance of sutures being better than one of the other methods.