This review examines the evidence from studies comparing different types of open surgery for people with groin hernia. We included only randomised studies comparing either 1) methods using synthetic mesh versus methods without mesh or 2) flat mesh methods versus plug and mesh methods. We divided mesh methods into flat mesh, plug and mesh or preperitoneal mesh and non-mesh methods into Shouldice or other non-mesh repair.
We found 20 studies comparing mesh with non-mesh repair and two studies comparing flat mesh with plug and mesh. For 13 studies we re-analysed data supplied by the study author, for four studies we received additional results from the study author and for five studies only published information was used.
There was strong evidence that fewer hernias recur after mesh repair than following non-mesh repair. There was a suggestion that people had less persisting pain after mesh repair but results were only available for nine out of 20 trials. Open mesh methods were shorter to perform than Shouldice procedures, but took longer than other types of non-mesh repair. We found no clear differences between mesh and non-mesh methods for operative complications and persisting numbness. Overall, people spent less time in hospital and returned to their usual activities quicker after mesh repair but this pattern was not observed for all studies.
We did not find clear evidence of differences between flat mesh repair and plug and mesh repair.