3. Mesh compared to non‐mesh repair for inguinal and femoral hernia repair, complications subgroups.
| Mesh compared to non‐mesh repair for inguinal and femoral hernia repair; complications subgroups | ||||||
| Patient or population: adults undergoing inguinal and femoral hernia repair Setting: multiple hospitals from small to large tertiary centres contributed results Intervention: mesh Comparison: non‐mesh repair | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with non‐mesh repair | risk with mesh | |||||
| Complications ‐ neurovascular or visceral injury | Study population | RR 0.61 (0.49 to 0.76) | 6293 (24 RCTs) | ⊕⊕⊕⊕ HIGH | Follow‐up: up to 4.3 years | |
| 6 per 100 | 4 per 100 (3 to 5) | |||||
| Complications ‐ wound infection | Study population | RR 1.29 (0.89 to 1.86) | 4540 (21 RCTs) | ⊕⊕⊝⊝ LOW 1 | Follow‐up: up to 5 years | |
| 2 per 100 | 3 per 100 (2 to 4) | |||||
| Complications ‐ haematoma | Study population | RR 0.88 (0.68 to 1.13) | 3773 (16 RCTs) | ⊕⊕⊝⊝ LOW 1 | Follow‐up: up to 5 years | |
| 6 per 100 | 5 per 100 (4 to 7) | |||||
| Complications ‐ seroma | Study population | RR 1.63 (1.03 to 2.59) | 2640 (14 RCTs) | ⊕⊕⊕⊝ MODERATE 2 | Follow‐up: up to 4 years | |
| 2 per 100 | 3 per 100 (2 to 5) | |||||
| Complications ‐ postoperative wound swelling | Study population | RR 4.56 (1.02 to 20.48) | 388 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 2 | Follow‐up: up to 5 years | |
| 1 per 100 | 5 per 100 (1 to 21) | |||||
| Complications ‐ wound dehiscence | Study population | RR 0.55 (0.12 to 2.48) | 329 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 | Follow‐up: up to 3 years | |
| 2 per 100 | 1 per 100 (0 to 6) | |||||
| Complications ‐ testicular injury or complications | Study population | RR 1.06 (0.63 to 1.76) | 3741 (14 RCTs) | ⊕⊕⊝⊝ LOW 1 | Follow‐up: up to 4 years | |
| 1 per 100 | 1 per 100 (1 to 2) | |||||
| Complications ‐ urinary retention | Study population | RR 0.53 (0.38 to 0.73) | 1539 (8 RCTs) | ⊕⊕⊕⊝ MODERATE 3 | The degree of heterogeneity may be related to differing definitions or measurement of urinary retention Follow‐up: up to 18 months |
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| 12 per 100 | 7 per 100 (5 to 9) | |||||
| Complications ‐ pain | No clear conclusion could be reached regarding post‐operative and chronic pain in mesh compared to non‐mesh hernia repair, as the studies used different methods and grading scores to determine severity of pain, as well as many different time intervals chosen for analysis. | ‐ | 4999 (22 RCTs) | ⊕⊝⊝⊝ VERY LOW 4 | No meaningful meta‐analysis was able to be performed due to inconsistent methods/lack of comparable endpoints. Follow‐up: up to 5 years |
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| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded two levels for imprecision (wide confidence interval overlapping no effect) and inconsistency (substantial heterogeneity)
2 Downgraded one level for imprecision (wide confidence interval, relatively small population)
3 Downgraded one level for inconsistency (substantial heterogeneity)
4 Downgraded three levels for risk of bias (subjective nature of outcome and various methods of measurement), inconsistency, imprecision and indirectness (various measures, including indirectly with analgesia use)