Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials

Background: Open tension-free methods of groin hernia repair have been wide ly adopted despite little rigorous evaluation. Methods: Information was assimilated from all randomized or quasi-randomize d trials comparing open mesh with open non-mesh methods to assess benefits and safety. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data it ems were extracted from reports, and quantitative or, if not possible, qual itative meta-analysis was performed. Results: Fifteen eligible trials, which included 4005 participants, were id entified. There were similar numbers of complications in each group, with f ew data to address short-term pain and length of stay in hospital. Return t o usual activities was quicker in the mesh group for seven of ten trials (P not significant). There were fewer reported recurrences in the mesh groups : overall 21 (1.4 per cent) of 1513 versus 72 (4.4 per cent) of 1634 (odds ratio 0.39 (95 per cent confidence interval 0.25-0.59); P < 0.001). Conclusion: Although the rigorous search maximized trial identification, fo rmal meta-analysis was limited by the variation in trial reporting. Within the data available, mesh repair was associated with fewer recurrences.