The current meta-analysis is to compare between intra-operative difficulties and early postoperative complications in laparoscopic inguinal hernia repair using conventional polypropylene mesh and 3D mesh. We have comprehensively searched and assessed the published literature regarding this topic. Our study included ten trials with 9264 participants, three trials regarding 3d mesh versus conventional mesh in laparoscopic inguinal hernia repair, three trials regarding 3d mesh and four trials regarding polyprolene mesh. Operative time was assessed in three included studies comparing between 3d mesh and polyprolene conventional mesh. Elkomy et al. stated 42 minutes mean time with standard deviation +-13 using 3d mesh and 45 minutes mean time with standard deviation +-15 using polyprolene, Shah et al. stated 15 minutes mean time with standard deviation +-0.7 using 3d mesh and 12 minutes mean time with standard deviation +-0.74 using polyprolene and Tajamul et al. stated 7 minutes mean time with standard deviation +-3 using 3d mesh and 7 minutes mean time with standard deviation +- 2.6 using polyprolene mesh.
Therefore, there is statistically significant heterogeneity among trials (P = 0.002, I2 = 84%), mean difference 1.17, 95% CI -2.18, 4.52,but there is no statistically significance in which p value in z test is 0.49. Regarding, Seroma was assessed in three included studies comparing between 3d mesh and polyprolene conventional mesh. Elkomy et al. stated 3 patients suffered from seroma using conventional mesh and 1 patient using 3d mesh in 6 months follow-up, Shah et al. stated 2 patients suffered from seroma using conventional mesh and 1 patient using 3d mesh in 3 months follow-up, and Tajamul et al. stated 2 patients suffered from seroma using conventional mesh and 1 patient using 3d mesh in 2 months follow-up. There was no significant heterogeneity among trials (P = 0.94, I2 = 0%), OR 0.4, 95% CI 0.1, 0.16 and no statically significance as z = 1.27. In comparison with four included studies using polyprolene conventional mesh. David J. et al. stated 2 patients suffered from seroma in 10 months follow-up, C.Tamme et al. stated 1 patient in 3 months follow-up, S.A Kapiris et al. stated 282 patients in 6 to 72 months follow-up and Stylianos kapiris et al. stated 11 patients in 50 months follow-up, with (P = 0.01, I2 = 99%). As regarding, recurrence was assessed in four included studies using conventional polyprolene mesh with follow-up at least 3 months. David J. et al. stated zero patients suffered from recurrence in 10 months follow-up, C.Tamme et al. stated 9 patients in 3 months follow-up, S.A. Kapiris et al. stated 22 patients in 6 to 72 months follow-up and Stylianos Kapiris et al. stated 1 patient in 50 months follow-up, with (P = 0.66, I2 = 0%) and pooled relative risk is 0.001.
Three included studies described recurrence using 3d mesh with follow-up at least 3 months. Mir et al. stated zero patients suffered from recurrence in 12 months follow-up, Tiwari et al. stated 1 patient in 12 months follow-up, and Bells et al. stated 1 patient in 24 months follow-up, with (P = 0.97, I2 = 0%) and pooled relative risk is 0.01. Therefore, there is no statistically significance between polyprolene and 3d mesh in recurrence rate. As regarding, recurrence was assessed in four included studies using conventional polyprolene mesh with follow-up at least 3 months. David J. et al. stated zero patients suffered from recurrence in 10 months follow-up, C.Tamme et al. stated 9 patients in 3 months follow-up, S.A. Kapiris et al. stated 22 patients in 6 to 72 months follow-up and Stylianos Kapiris et al. stated 1 patient in 50 months follow-up, with (P = 0.66, I2 = 0%) and pooled relative risk is 0.001. Three included studies described recurrence using 3d mesh with follow-up at least 3 months. Mir et al. stated zero patients suffered from recurrence in 12 months follow-up, Tiwari et al. stated 1 patient in 12 months follow-up, and Bells et al. stated 1 patient in 24 months follow-up, with (P = 0.97, I2 = 0%) and pooled relative risk is 0.01. Therefore, there is no statistically significance between polyprolene and 3d mesh in recurrence rate. Chronic pain is one of the most serious long-term complications following groin hernia repair. Surgical dissection, mesh fixation, and mesh-induced entrapment have been cited as the potential causes of groin pain .
Chronic pain was assessed in three studies comparing between 3d mesh and polyprolene conventional mesh. Elkomy et al. stated 8 patients suffered from chronic pain using conventional mesh from 15 total patients and 4 patients using 3d mesh in 6 months follow-up from 15 total patients, Shah et al. stated 4 patients suffered from chronic pain in 6 months using conventional mesh from 25 total patients and 2 patients using 3d mesh from 25 total patients, while Tajamul et al. stated 2 patients suffered from chronic pain using conventional mesh from 30 total patients and 1 patient using 3d mesh in 2 months follow-up from 30 total patients. There was no significant heterogeneity among trials (P = 0.55, I2 = 0%), OR 0.61, 95% CI 0.22, 1.68 and no statistically significance Z = 0.96.
Chronic pain was assessed in four included studies using polyprolene conventional mesh .David J. et al. stated 2 patients suffered from chronic pain in 10 months follow-up, C. tamme et al. stated 9 patients suffered from chronic pain in 3 months follow-up, S.A Kapiris et al. stated 17 patients suffered from chronic pain in 6to 72 months follow-up and Stylianos kapiris et al. stated 1 patients suffered from chronic pain in 50 months follow-up (P = 0.189, I2 = 37%) with pooled relative risk 0.02.
Chronic pain was assessed in three included studies using 3d mesh Mir et al. stated 2 patients suffered from chronic pain in 12 months follow-up, Pyrianka et al. stated 2 patients suffered from chronic pain in 12 months follow-up and bells et al. stated 2 patients in 24 months follow-up (P = 0.49, I2 = 0%) with pooled relative risk 0.02.
Our limitation is few number of studies comparing both 3d mesh and conventional polyprolene. In addition, heterogeneity was present in the results but, with no significance due to the several factors discussed previously. We also noted high risk of bias in some of the included studies due to either the patient selection or methodology.