Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and the intervention is more effective/beneficial than the comparison for key outcomes.
Population: Adults with clinically diagnosed inguinal or femoral hernia requiring surgery
Intervention: Open or laparoscopic mesh repair
Comparison: Non-mesh repair
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Hernia recurrence (up to 5 years' follow‐up) | Favors intervention | Moderate |
Surgical complications (up to 4.3 years' follow‐up): neurovascular or visceral injury ᵃ | Occurs more commonly with non-mesh repair compared with mesh repair (favors intervention) | High |
Surgical complications (up to 4.3 years' follow‐up): seroma or post-operative wound swelling | Occurs more commonly with mesh repair compared with non-mesh repair (favors comparison) | GRADE assessment not performed for this outcome |
Mortality (30 days post‐operation) | See note ᵇ | GRADE assessment not performed for this outcome |
Duration of surgery (minutes) | Favors intervention | Very Low |
Duration of postoperative stay (days) | Favors intervention | Low |
Time to return to full activities of daily living (ADLs) (days) | Favors intervention | Low |
Conversion from laparoscopic to open approach | See note ᶜ | Low |
Note The overall rating in this table reflects the only primary outcomes of hernia recurrence and surgical complications (neurovascular or visceral injury) which were assessed by GRADE. The other outcomes in this table either did not have a GRADE evaluation or are secondary outcomes as defined by the Cochrane review which underpins this Cochrane Clinical Answer (CCA). ᵃ There was also a statistically significant difference between treatment groups showing that the surgical complication of urinary retention occurred more commonly with non-mesh repair compared with mesh repair. However, GRADE assessment was not performed for this outcome. ᵇ No events in either group. ᶜ No conversions to open surgery for any laparoscopic mesh repair procedure.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How does mesh compare with non‐mesh for inguinal hernia repair?
- What are the effects of antibiotic prophylaxis for preventing wound infection in adults undergoing open inguinal or femoral hernioplasty surgery?
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