Eligible studies were of patients who underwent laparoscopic total extraperitoneal repair of inguinal hernia. Studies needed to compare traditional mechanical mesh fixation with glue fixation. Case reports were excluded. The primary outcomes of interest were recurrence and chronic pain (chronic groin pain was defined as three months to one year after surgery). Eligible secondary outcomes were operative time, seroma formation, postoperative pain, length of hospital stay, time to resuming work and normal outdoor activities, and wound infection (definitions reported in the paper).
The included studies were conducted in Europe or China. Most patients were men. Mean age ranged from 55 to 66 years. Patients had unilateral, bilateral or recurrent hernias. All studies except one used a flat sheet of mesh; none of them reported the proximity between tack placement and deep ring. There was some variation in the amount of glue used in the fibrin sealant groups and in the type and number of tacks used in mechanical fixation.
Two reviewers selected the studies for inclusion.