Sac Transection Versus Complete Sac Reduction in Laparoscopic Hernia Repair: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background

Laparoscopic inguinal hernia repair is widely adopted for its minimally invasive benefits, but the optimal management of the hernia sac—transection or complete reduction—remains uncertain.

Methods

A comprehensive literature search was conducted in both English and Chinese databases to identify randomized controlled trials (RCTs) comparing sac transection with complete sac reduction in laparoscopic inguinal hernia repair. Meta-analysis was performed using RevMan 5.3 software. The quality of evidence for each outcome was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results

A total of 8 RCTs involving 627 patients with inguinal hernia were included. Meta-analysis indicated that, compared to the completely reduced sac (RS) group, the transected sac (TS) group had shorter operation time (MD = −13.95 minutes, 95% CI (−20.56, −7.34), P < .0001) and a lower overall postoperative complication rate (RR = 0.52, 95% CI (0.35, 0.78), P = .001). There were no statistically significant differences between the two groups in terms of postoperative 24-hour VAS pain scores (MD = −0.83, 95% CI (−2.60, 0.94), P = .36), length of hospital stay (MD = −0.39 days, 95% CI (−0.80, 0.01), P = .05), incidence of seroma (RR = 1.41, 95% CI (0.88, 2.26), P = .15), and recurrence rate (RR = 0.67, 95% CI (0.26, 1.71), P = .40).

Conclusion

The results of this meta-analysis indicate that sac transection in laparoscopic inguinal hernia repair provides the benefits of shorter operation times and lower rates of overall postoperative complications.