Partially or completely absorbable versus nonabsorbable mesh repair for inguinal hernia: A systematic review and meta-analysis

Background: The long-term complications after implantation of a prosthetic mesh in inguinal hernia repair remain a concern. Recent development of new mesh materials has resulted in meshes with lower weight (LW) and with better biocompatibility. Aim: To compare hernia repair with partially or completely absorbable meshes with conventional nonabsorbable mesh repair. Methods: A literature search was performed using Medline, Embase, and Cochrane databases to identify relevant randomized controlled trials and comparative studies. The primary outcomes were: hospital stay, time taken to return to work, seroma, hematoma, wound infection, groin pain, chronic pain, foreign body sensation, recurrence, and testicular atrophy. Results: Nine trials containing 3133 inguinal hernia repairs were analyzed. There was no significant difference between the groups for hospital stay, time taken to return to work, hematoma, wound infection, testicular atrophy, or recurrence. The incidence of seroma was greater after LW nonabsorbable mesh repair compared with high weight nonabsorbable mesh repair [pooled odds ratio 52.88, 95% confidence interval (CI)=3.11-898.19, P=0.006]. The use of LW meshes was associated with a significant reduction in prolonged pain (pooled effect size 0.13, 95% CI=-0.33-0.59, P=0.58) and foreign body sensation (pooled odds ratio 0.5, 95% CI=0.2-1.21, P=0.12). These effects were seen with both LW nonabsorbable and absorbable meshes compared with high weight nonabsorbable meshes. Conclusions: Absorbable and nonabsorbable mesh repair of inguinal hernias do not seem to afford any significant benefit over each other. It is the weight of meshes that seems to have significant influence on long-term complications after mesh repair.