Self-gripping versus sutured mesh fixation methods for open inguinal hernia repair: A systematic review of clinical trials and observational studies Ammar Ismail, a,b,c Abdelrahman Ibrahim Abushouk, b,c,d Ahmed Elmaraezy, a,b,c Ahmed Helal Abdelkarim, b,e,f Mohamed Shehata, b,e,f Mohamed Abozaid, a,b Hussien Ahmed, b,e,f and Ahmed Negida, b,e,f Cairo and El-Sharkia, Egypt Background. We performed this systematic review and meta-analysis to compare the outcomes of Lichenstein hernia repair using either self-gripping mesh or sutured mesh fixation techniques. Methods. We searched PubMed, Cochrane CENTRAL, Scopus, Embase, and Web of Science for all clinical trials and observational studies that compared self-gripping mesh versus sutured mesh fixation in Lichtenstein hernia repair. Combined outcomes were pooled as odds ratios or mean differences in a fixed-effect model, using Comprehensive Meta-Analysis software for Windows. Results. Twelve randomized, controlled trials and 5 cohort studies (n = 3,722 patients) were included in the final analysis. The two groups, using self-gripping mesh or sutured mesh fixation, did not differ significantly in terms of recurrence rate (odds ratio = 0.66, 95% confidence interval 0.18–2.44; P = .54) or postoperative chronic groin pain (odds ratio = 0.75, 95% confidence interval 0.54–1.05; P = .09). The operative time was less in the self-gripping mesh group (mean difference = À7.85, 95% confidence interval À9.94 to À5.76; P < .0001). For safety analysis, there were comparable risks be- tween self-gripping mesh and sutured mesh fixation groups in terms of postoperative infection (odds ratio = 0.81, 95% confidence interval 0.53–1.23; P = .32), postoperative hematoma (odds ra- tio = 0.97, 95% confidence interval 0.7–1.36; P = .9), and urinary retention (odds ratio = 0.66, 95% confidence interval 0.18–2.44; P = .54). Conclusion. Data from our analysis did not favor either of the two fixation techniques over the other in terms of recurrence or postoperative chronic groin pain. Decreased operative time in the self-gripping mesh group cannot justify a recommendation for its routine use. Longer follow-up studies are needed to compare the risk of long-term recurrence for both meshes. (Surgery 2017;j:j-j.) From the Faculty of Medicine, a Al-Azhar University, Cairo, Egypt; the NovaMed Medical Research Associa- tion, b Cairo, Egypt; the Medical Research Group of Egypt, c Cairo, Egypt; the Faculty of Medicine, d Ain Shams University, Cairo, Egypt; and the Faculty of Medicine e and the Student Research Unit, f Zagazig University, El- Sharkia, Egypt TENSION-FREE HERNIA REPAIR, described initially by Lichtenstein 1,2 is the gold standard technique for open inguinal hernioplasty because this approach has a significantly less recurrence rate of 0.3% to 2.2% in comparison to 4.4% to 17% for classic her- niorrhaphies. 3,4 In this procedure, the surgeon re- duces the hernia sac, inserts a prosthetic mesh to strengthen the inguinal canal, and fixates it with sutures to the pubic tubercle and inguinal ligament. 1 Considering the low recurrence rates after this procedure, postoperative chronic groin pain (CGP) is the most relevant outcome, 5 with remark- able variation in the reported frequency among published clinical trials, ranging between 11% and 54%, due to the variable terminology and assessment scales used in these trials. 6,7 This AH and MS contributed equally to this work. Accepted for publication December 22, 2016. Reprint requests: Abdelrahman Ibrahim Abushouk, MD, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt. E-mail: Abdelrahman.abushouk@med.asu.edu.eg. 0039-6060/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2016.12.028 SURGERY 1 ARTICLE IN PRESS