Previous research has shown that the repair of a recurrent inguinal hernia is subject to a greater risk of additional recurrence. Further, bilateral inguinal hernia is subject to a greater recurrence risk than unilateral inguinal hernia. These increased risks may be due to certain anatomical difficulties that complicate the surgical approach in these types of patients. Some clinicians have suggested that laparoscopic approaches are better suited to recurrent and bilateral hernias, and in we delineate separate comparisons for primary, bilateral, and recurrent hernia.
A systematic search will be performed using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database, to include RCTs of different mesh fixation methods (or fixation vs no fixation) during open inguinal hernia repair. The risk of bias in included RCTs will be evaluated according to the Cochrane Handbook V.5.1.0. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be performed to compare the efficacy of different mesh fixation methods.