Evaluating mesh fixation techniques for ventral hernia repair: A systematic review and network meta-analysis of randomised control trials

Introduction: There is uncertainty regarding the optimal mesh fixation techniques for laparoscopic ventral and incisional hernia repair. Aim: To perform a systematic review and network meta -analysis of randomised control trials (RCTs) to investigate the advantages and disadvantages associated with absorbable tacks, non -absorbable tacks, non -absorbable sutures, non -absorbable staples, absorbable synthetic glue, absorbable sutures and non -absorbable tacks, and nonabsorbable sutures and non -absorbable tacks. Methods: A systematic review was performed as per PRISMA-NMA guidelines. Odds ratios (ORs) and mean differences (MDs) were extracted to compare the efficacy of the surgical approaches. Results: Nine RCTs were included with 707 patients. Short-term pain was significantly reduced in non -absorbable staples (MD; -1.56, confidence interval (CI); -2.93 to -0.19) and non -absorbable sutures (MD; -1.00, CI; -1.60 to -0.40) relative to absorbable tacks. Recurrence, length of stay, operative time, conversion to open surgery, seroma and haematoma formation were unaffected by mesh fixation technique. Conclusion: Short-term post -operative pain maybe reduced by the use of non -absorbable sutures and nonabsorbable staples. There is clinical equipoise between each modality in relation to recurrence, length of stay, and operative time.