Comparison of mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair: a network meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

JIANG Weirong ¹ ,  MENG Yong ^1,2 , GAO Mingqing ² , YU Yongjiang ^3,4 , LI Rui ¹ , CHEN Wenhao ¹ , XU Zhen ¹

1. The Fourth Department of General Surgery, Xi’an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi’an 710018, P. R. China;
2. Northwest University School of Medicine, Xi’an 710069, P. R. China;
3. Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730030, P. R. China;
4. The First School of Clinical Medicine of Lanzhou University, Lanzhou 730030, P. R. China;

Corresponding?author：

MENG Yong, Email: my176@126.com

Keywords：

inguinal hernia; trans-abdominal preperitoneal hernia repair; mesh fixation; postoperative complication; network meta-analysis

DOI：

10.7507/1007-9424.202208086

Video：

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Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) by using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases were retrieved to collect randomized controlled trials (RCTs) studies comparing different fixation methods of patches in laparoscopic TAPP. The retrieval time limit was from the establishment of the database to March 1, 2022. After two researchers independently screened the literatures, extracted the data, and evaluated the bias risk, Bayesian network meta-analysis was conducted by using R4.1.2 software. Results Twenty-nine RCTs were included, including 4 095 patients. The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation [OR=0.06, 95%CI (0.01, 0.26), P＜0.001], glue fixation [OR=0.21, 95%CI (0.04, 0.53), P=0.001] and self-gripping mesh [OR=0.09, 95%CI (0.01, 0.52), P=0.009], the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation [OR=0.10, 95%CI (0.01, 0.70), P= 0.020]. Postoperative visual analogue scale of staples fixation was higher than those of no fixation [MD=–0.90, 95%CI (–1.49, –0.33), P=0.002] and glue fixation [MD=–0.92, 95%CI (–1.35, –0.49), P＜0.001], the postoperative visual analogue scale with suture fixation was higher than those of no fixation [MD=–0.83, 95%CI (–1.61, –0.08), P=0.030] and glue fixation [MD=–0.85, 95%CI (–1.56, –0.13), P=0.020]. There was no significant difference in the incidence of seroma and hematoma, hospital stay and hernia recurrence among different fixation methods. Conclusions The network meta-analysis shows that medical glue and self-gripping mesh have certain advantages in reducing chronic pain after surgery, which may be the better patch fixation method in TAPP. The non fixation mesh will not increase the risk of postoperative recurrence, and can be used in clinical practice. This conclusion needs to be further verified by large sample, long-term follow-up and high-quality RCTs.

Citation： JIANG Weirong, MENG Yong, GAO Mingqing, YU Yongjiang, LI Rui, CHEN Wenhao, XU Zhen. Comparison of mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair: a network meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(2): 204-213. doi: 10.7507/1007-9424.202208086 Copy

1.	The HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
2.	寧彩虹, 黃耿文, 林嘉晏, 等. 腹腔鏡經腹腹膜前疝修補日間手術的臨床價值分析. 中國普通外科雜志, 2021, 30(4): 399-405.
3.	Aiolfi A, Cavalli M, Del Ferraro S, et al. Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials. Hernia, 2021, 25(5): 1147-1157.
4.	于志遠, 楊詩語, 柳博文, 等. 腹腔鏡經腹膜前腹股溝疝修補術后慢性疼痛的風險預測模型. 中國普外基礎與臨床雜志, 2022, 29(6): 761-767.
5.	Arregui ME, Navarrete J, Davis CJ, et al. Laparoscopic inguinal herniorrhaphy. Techniques and controversies. Surg Clin North Am, 1993, 73(3): 513-527.
6.	李瑞斌, 吳攀, 萬智恒. 經腹腹膜前腹腔鏡腹股溝疝修補術在腹股溝疝無張力修補中的應用. 中國普通外科雜志, 2020, 29(10): 1275-1279.
7.	孫斌杰, 李云鋒, 余坤, 等. 腹股溝疝術后慢性疼痛的診療進展. 國際外科學雜志, 2021, 48(7): 493-499.
8.	Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10: Ed000142. doi: 10.1002/14651858.ED000142.
9.	Ahmed M, Kumar V, Akram M, et al. Post-operative pain and early complications in patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair using mesh fixation with sutures versus tackers. P J M H S, 2021, 15(1): 537-539.
10.	Boldo E, Armelles A, Perez de Lucia G, et al. Pain after laparascopic bilateral hernioplasty: early results of a prospective randomized double-blind study comparing fibrin versus staples. Surg Endosc, 2008, 22(5): 1206-1209.
11.	Bruegger L, Bloesch M, Ipaktchi R, et al. Objective hypoesthesia and pain after transabdominal preperitoneal hernioplasty: a prospective, randomized study comparing tissue adhesive versus spiral tacks. Surg Endosc, 2012, 26(4): 1079-1085.
12.	Cambal M, Zonca P, Hrbaty B. Comparison of self-gripping mesh with mesh fixation with fibrin-glue in laparoscopic hernia repair (TAPP). Bratisl Lek Listy, 2012, 113(2): 103-107.
13.	Ferrarese A, Bindi M, Rivelli M, et al. Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients. Open Med (Wars), 2016, 11(1): 497-508.
14.	Ferzli GS, Eldo Frezza E, Pecoraro AM Jr, et al. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg, 1999, 188(5): 461-465.
15.	Fortelny RH, Petter-Puchner AH, May C, et al. The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life:results of a randomized controlled study. Surg Endosc, 2012, 26(1): 249-254.
16.	Fumagalli Romario U, Puccetti F, Elmore U, et al. Self-gripping mesh versus staple fixation in laparoscopic inguinal hernia repair: a prospective comparison. Surg Endosc, 2013, 27(5): 1798-1802.
17.	Habeeb TAAM, Mokhtar MM, Sieda B, et al. Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: short and long term outcome. Randomized controlled clinical trial. Int J Surg, 2020, 83: 117-124.
18.	Ielpo B, Nu?ez J, Ferri V, et al. Laparoscopic inguinal hernia repair: cost-effectiveness analysis of trend modifications of the technique. Updates Surg, 2021, 73(5): 1945-1953.
19.	Kalidarei B, Mahmoodieh M, Sharbu Z. Comparison of mesh fixation and nonfixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia. Formos J Surg, 2019, 52(6): 212-220.
20.	Khalil AA, Ebeid EF, Ismail AI. Comparative study between the use of self-fixating mesh and non-self-fixating mesh in laparoscopic inguinal hernia repair transabdominal preperitoneal technique. Egyp J Surg, 2019, 38(3): 588-596.
21.	Leibl BJ, Kraft B, Redecke JD, et al. Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial. World J Surg, 2002, 26(12): 1481-1484.
22.	Li W, Sun D, Sun Y, et al. The effect of transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic pain and quality of life of patients: mesh fixation versus non-fixation. Surg Endosc, 2017, 31(10): 4238-4243.
23.	Lovisetto F, Zonta S, Rota E, et al. Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg, 2007, 245(2): 222-231.
24.	Olmi S, Scaini A, Erba L, et al. Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery, 2007, 142(1): 40-46.
25.	Qureshi S, Ghazanfar S, Leghari AA, et al. A comparative follow up study of transabdominal preperitoneal mesh repair in inguinal hernias with or without mesh fixation. J Pak Med Assoc, 2021, 71(1A): 28-30.
26.	Smith AI, Royston CM, Sedman PC. Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. A prospective randomized trial. Surg Endosc, 1999, 13(8): 804-806.
27.	Tarasenko SV, Bogomolov AY, Natal’skiy AA, et al. Laparoscopic inguinal hernia repair without fixation. Kazan Med J , 2018, 99(4): 712-716.
28.	Tolver MA, Rosenberg J, Juul P, et al. Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair. Surg Endosc, 2013, 27(8): 2727-2733.
29.	Torre F, Madureira F, Hernández M. Comparison of postoperative pain in laparoscopic inguinal hernia repairs by the transabdominal preperitoneal technique with self-gripping mesh versus tacker fixation. Int J Abdom Wall Hernia Surg, 2020, 3(2): 45-49.
30.	Wang L, Jin X, Wang H, et al. Laparoscopic transabdominal preperitoneal procedure with and without mesh-fixation for inguinal hernia repairs. Int J Clin Exp Med, 2018, 11(8): 8651-8655.
31.	Zayed ME, Essa MS. Impact of mesh fixation vs non-fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair on chronic groin pain and quality of life: a prospective randomized study. Egyp J Surg, 2020, 39(3): 574-581.
32.	馮陽, 李廣闊, 李力, 等. 自固定網片與聚丙烯平片用于成人TAPP的效果比較研究. 西南國防醫藥, 2015, 25(4): 399-402.
33.	郭春海, 吳永哲, 魏金平, 等. 腹腔鏡經腹腹膜前疝修補術中各種補片固定方法的療效觀察. 中華疝和腹壁外科雜志(電子版), 2020, 14(1): 47-50.
34.	黃國增, 陳蔭曾, 李旺, 等. 免釘合器腹腔鏡下經腹腔腹膜前法腹股溝疝修補術的臨床研究. 實用醫學雜志, 2017, 33(13): 2180-2183.
35.	王明剛, 陳杰, 申英末, 等. 腹腔鏡腹股溝疝修補術中疝固定器與醫用膠固定補片的療效研究. 北京醫學, 2010, 32(7): 528-530.
36.	吳國斌, 蘇玉國, 王炬, 等. 腹腔鏡腹股溝疝修補術中疝固定器與醫用膠固定補片的療效比較研究. 現代中西醫結合雜志, 2017, 26(25): 2789-2791.
37.	張志勇. 腹腔鏡腹股溝疝修補術兩種補片固定方法的前瞻性對比研究. 腹腔鏡外科雜志, 2006, 11(3): 210-211.
38.	Beel E, Berrevoet F. Surgical treatment for chronic pain after inguinal hernia repair: a systematic literature review. Langenbecks Arch Surg, 2022, 407(2): 541-548.
39.	Takayama Y, Kaneoka Y, Maeda A, et al. Short- and long-term outcomes of transabdominal preperitoneal, open mesh plug and open tissue inguinal hernia repair. World J Surg, 2021, 45(3): 730-737.
40.	安麗娟, 俞永江. 腹股溝疝修補術后慢性腹股溝疼痛危險因素的研究進展. 中國普外基礎與臨床雜志, 2020, 27(5): 629-633.
41.	Techapongsatorn S, Tansawet A, Kasetsermwiriya W, et al. Mesh fixation technique in totally extraperitoneal inguinal hernia repair—A network meta-analysis. Surgeon, 2019, 17(4): 215-224.
42.	Kaul A, Hutfless S, Le H, et al. Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc, 2012, 26(5): 1269-1278.
43.	Reinpold W, Schroeder AD, Schroeder M, et al. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia, 2015, 19(4): 539-548.
44.	Forester B, Attaar M, Chirayil S, et al. Predictors of chronic pain after laparoscopic inguinal hernia repair. Surgery, 2021, 169(3): 586-594.
45.	Bjurstr?m MF, Irwin MR, Chen DC, et al. Sex differences, sleep disturbance and risk of persistent pain associated with groin hernia surgery: a nationwide register-based cohort study. J Pain, 2021, 22(11): 1360-1370.
46.	Romain B, Fabacher T, Ortega-Deballon P, et al. Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up. Hernia, 2022, 26(1): 189-200.
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1. The HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
2. 寧彩虹, 黃耿文, 林嘉晏, 等. 腹腔鏡經腹腹膜前疝修補日間手術的臨床價值分析. 中國普通外科雜志, 2021, 30(4): 399-405.
3. Aiolfi A, Cavalli M, Del Ferraro S, et al. Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials. Hernia, 2021, 25(5): 1147-1157.
4. 于志遠, 楊詩語, 柳博文, 等. 腹腔鏡經腹膜前腹股溝疝修補術后慢性疼痛的風險預測模型. 中國普外基礎與臨床雜志, 2022, 29(6): 761-767.
5. Arregui ME, Navarrete J, Davis CJ, et al. Laparoscopic inguinal herniorrhaphy. Techniques and controversies. Surg Clin North Am, 1993, 73(3): 513-527.
6. 李瑞斌, 吳攀, 萬智恒. 經腹腹膜前腹腔鏡腹股溝疝修補術在腹股溝疝無張力修補中的應用. 中國普通外科雜志, 2020, 29(10): 1275-1279.
7. 孫斌杰, 李云鋒, 余坤, 等. 腹股溝疝術后慢性疼痛的診療進展. 國際外科學雜志, 2021, 48(7): 493-499.
8. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev, 2019, 10: Ed000142. doi: 10.1002/14651858.ED000142.
9. Ahmed M, Kumar V, Akram M, et al. Post-operative pain and early complications in patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair using mesh fixation with sutures versus tackers. P J M H S, 2021, 15(1): 537-539.
10. Boldo E, Armelles A, Perez de Lucia G, et al. Pain after laparascopic bilateral hernioplasty: early results of a prospective randomized double-blind study comparing fibrin versus staples. Surg Endosc, 2008, 22(5): 1206-1209.
11. Bruegger L, Bloesch M, Ipaktchi R, et al. Objective hypoesthesia and pain after transabdominal preperitoneal hernioplasty: a prospective, randomized study comparing tissue adhesive versus spiral tacks. Surg Endosc, 2012, 26(4): 1079-1085.
12. Cambal M, Zonca P, Hrbaty B. Comparison of self-gripping mesh with mesh fixation with fibrin-glue in laparoscopic hernia repair (TAPP). Bratisl Lek Listy, 2012, 113(2): 103-107.
13. Ferrarese A, Bindi M, Rivelli M, et al. Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients. Open Med (Wars), 2016, 11(1): 497-508.
14. Ferzli GS, Eldo Frezza E, Pecoraro AM Jr, et al. Prospective randomized study of stapled versus unstapled mesh in a laparoscopic preperitoneal inguinal hernia repair. J Am Coll Surg, 1999, 188(5): 461-465.
15. Fortelny RH, Petter-Puchner AH, May C, et al. The impact of atraumatic fibrin sealant vs. staple mesh fixation in TAPP hernia repair on chronic pain and quality of life:results of a randomized controlled study. Surg Endosc, 2012, 26(1): 249-254.
16. Fumagalli Romario U, Puccetti F, Elmore U, et al. Self-gripping mesh versus staple fixation in laparoscopic inguinal hernia repair: a prospective comparison. Surg Endosc, 2013, 27(5): 1798-1802.
17. Habeeb TAAM, Mokhtar MM, Sieda B, et al. Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: short and long term outcome. Randomized controlled clinical trial. Int J Surg, 2020, 83: 117-124.
18. Ielpo B, Nu?ez J, Ferri V, et al. Laparoscopic inguinal hernia repair: cost-effectiveness analysis of trend modifications of the technique. Updates Surg, 2021, 73(5): 1945-1953.
19. Kalidarei B, Mahmoodieh M, Sharbu Z. Comparison of mesh fixation and nonfixation in laparoscopic transabdominal preperitoneal repair of inguinal hernia. Formos J Surg, 2019, 52(6): 212-220.
20. Khalil AA, Ebeid EF, Ismail AI. Comparative study between the use of self-fixating mesh and non-self-fixating mesh in laparoscopic inguinal hernia repair transabdominal preperitoneal technique. Egyp J Surg, 2019, 38(3): 588-596.
21. Leibl BJ, Kraft B, Redecke JD, et al. Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial. World J Surg, 2002, 26(12): 1481-1484.
22. Li W, Sun D, Sun Y, et al. The effect of transabdominal preperitoneal (TAPP) inguinal hernioplasty on chronic pain and quality of life of patients: mesh fixation versus non-fixation. Surg Endosc, 2017, 31(10): 4238-4243.
23. Lovisetto F, Zonta S, Rota E, et al. Use of human fibrin glue (Tissucol) versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty: a prospective, randomized study. Ann Surg, 2007, 245(2): 222-231.
24. Olmi S, Scaini A, Erba L, et al. Quantification of pain in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty identifies marked differences between prosthesis fixation systems. Surgery, 2007, 142(1): 40-46.
25. Qureshi S, Ghazanfar S, Leghari AA, et al. A comparative follow up study of transabdominal preperitoneal mesh repair in inguinal hernias with or without mesh fixation. J Pak Med Assoc, 2021, 71(1A): 28-30.
26. Smith AI, Royston CM, Sedman PC. Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. A prospective randomized trial. Surg Endosc, 1999, 13(8): 804-806.
27. Tarasenko SV, Bogomolov AY, Natal’skiy AA, et al. Laparoscopic inguinal hernia repair without fixation. Kazan Med J , 2018, 99(4): 712-716.
28. Tolver MA, Rosenberg J, Juul P, et al. Randomized clinical trial of fibrin glue versus tacked fixation in laparoscopic groin hernia repair. Surg Endosc, 2013, 27(8): 2727-2733.
29. Torre F, Madureira F, Hernández M. Comparison of postoperative pain in laparoscopic inguinal hernia repairs by the transabdominal preperitoneal technique with self-gripping mesh versus tacker fixation. Int J Abdom Wall Hernia Surg, 2020, 3(2): 45-49.
30. Wang L, Jin X, Wang H, et al. Laparoscopic transabdominal preperitoneal procedure with and without mesh-fixation for inguinal hernia repairs. Int J Clin Exp Med, 2018, 11(8): 8651-8655.
31. Zayed ME, Essa MS. Impact of mesh fixation vs non-fixation in laparoscopic transabdominal preperitoneal inguinal hernia repair on chronic groin pain and quality of life: a prospective randomized study. Egyp J Surg, 2020, 39(3): 574-581.
32. 馮陽, 李廣闊, 李力, 等. 自固定網片與聚丙烯平片用于成人TAPP的效果比較研究. 西南國防醫藥, 2015, 25(4): 399-402.
33. 郭春海, 吳永哲, 魏金平, 等. 腹腔鏡經腹腹膜前疝修補術中各種補片固定方法的療效觀察. 中華疝和腹壁外科雜志(電子版), 2020, 14(1): 47-50.
34. 黃國增, 陳蔭曾, 李旺, 等. 免釘合器腹腔鏡下經腹腔腹膜前法腹股溝疝修補術的臨床研究. 實用醫學雜志, 2017, 33(13): 2180-2183.
35. 王明剛, 陳杰, 申英末, 等. 腹腔鏡腹股溝疝修補術中疝固定器與醫用膠固定補片的療效研究. 北京醫學, 2010, 32(7): 528-530.
36. 吳國斌, 蘇玉國, 王炬, 等. 腹腔鏡腹股溝疝修補術中疝固定器與醫用膠固定補片的療效比較研究. 現代中西醫結合雜志, 2017, 26(25): 2789-2791.
37. 張志勇. 腹腔鏡腹股溝疝修補術兩種補片固定方法的前瞻性對比研究. 腹腔鏡外科雜志, 2006, 11(3): 210-211.
38. Beel E, Berrevoet F. Surgical treatment for chronic pain after inguinal hernia repair: a systematic literature review. Langenbecks Arch Surg, 2022, 407(2): 541-548.
39. Takayama Y, Kaneoka Y, Maeda A, et al. Short- and long-term outcomes of transabdominal preperitoneal, open mesh plug and open tissue inguinal hernia repair. World J Surg, 2021, 45(3): 730-737.
40. 安麗娟, 俞永江. 腹股溝疝修補術后慢性腹股溝疼痛危險因素的研究進展. 中國普外基礎與臨床雜志, 2020, 27(5): 629-633.
41. Techapongsatorn S, Tansawet A, Kasetsermwiriya W, et al. Mesh fixation technique in totally extraperitoneal inguinal hernia repair—A network meta-analysis. Surgeon, 2019, 17(4): 215-224.
42. Kaul A, Hutfless S, Le H, et al. Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc, 2012, 26(5): 1269-1278.
43. Reinpold W, Schroeder AD, Schroeder M, et al. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia, 2015, 19(4): 539-548.
44. Forester B, Attaar M, Chirayil S, et al. Predictors of chronic pain after laparoscopic inguinal hernia repair. Surgery, 2021, 169(3): 586-594.
45. Bjurstr?m MF, Irwin MR, Chen DC, et al. Sex differences, sleep disturbance and risk of persistent pain associated with groin hernia surgery: a nationwide register-based cohort study. J Pain, 2021, 22(11): 1360-1370.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair: a network meta-analysis

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