Postoperative drainage after totally extra-peritoneal inguinal hernia repair: systematic review and meta-analysis
Bibliographic record
Abstract
Introduction: Total extra-peritoneal (TEP) repair is one of minimally invasive treatment options for inguinal hernia repair. While TEP repair has several advantages over other minimally invasive techniques, the main drawback of TEP is higher incidence of seroma formation. The goal of our study was to systematically review and meta analyze existing evidence on the role of postoperative drainage post TEP surgery for groin hernia repair and to assess risks associated with use of drains. Aim: The goal of our study was to systematically review and meta-analyse the existing evidence on the role of postoperative drainage post TEP surgery for groin hernia repair and to assess risks associated with the use of drains. Methods: A systematic literature search of major databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies that compared usage of drain with control in patients undergoing TEP. Primary outcomes for this study were: seroma rates, surgical site infection rates (SSI), urinary retention, postoperative pain at 24 hours after operation, postoperative pain at one week after operation, chronic pain and quality of life scores (QoL). Random-effects and Fixed-effects models to analyse data were used. Risk difference (RD) was calculated for dichotomous outcomes (seroma, SSI, urinary retention) with 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I2 test. Risk of bias was assessed using the Newcastle-Ottawa scale for observational studies and Risk of Bias Tool -2 for randomised controlled trials (RCTs). Results: There were 5 studies that enrolled 1659 participants (1288 in the drain group and 371 in the control group). Three studies were observational and two were RCTs. The meta-analysis of included studies has confirmed significant risk difference in the occurrence of seroma in favour of using postoperative drain (RD -0.19 [-0.26, -0.12], test for overall effect: Z = 5.24 (p<0.00001), I2 = 59%). There was significant clinical and statistical heterogeneity in findings. Conclusions: Use of postoperative drains after TEP is safe and was shown to be associated with a reduced risk of seroma formation, although a low number of studies was included with a predominance of observational data. There was significant clinical and statistical heterogeneity in findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.028 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".