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I now have all 10 records in full. Here is a synthesized summary of the findings:
Synthesis: Hernia Repair RCT/Trial Evidence (Elicit Review)
This review covers 10 clinical trials from ClinicalTrials.gov, spanning 2011-2026, focused on hernia repair techniques. The majority have not posted results, which severely limits evidence synthesis.
Overview at a Glance
| # | Trial | Year | Design | N | Hernia Type | Comparison | Results Available? |
|---|---|---|---|---|---|---|---|
| 1 | NCT03255239 | 2017 | RCT | 120 (est.) | Ventral (<3 cm) | Preperitoneal mesh vs. retromuscular mesh vs. suture | No |
| 2 | NCT01026935 | 2011 | RCT, double-blind | 398 (actual) | Inguinal | Lichtenstein (sutured PP mesh) vs. ProGrip (self-fixating mesh) | No (published separately) |
| 3 | NCT06474403 | 2026 | RCT, double-blind | 50 (est.) | Parastomal | Laparoscopic TEP (Sugabecker modification) vs. traditional Sugabecker/Paul | Pending |
| 4 | NCT01411397 | 2011 | Non-RCT, prospective | 163 | Strangulated | Mesh hernioplasty ± intestinal resection | No |
| 5 | NCT03203343 | 2018 | RCT | 32 | Pediatric inguinal | Laparoscopic vs. open repair (inflammatory biomarkers) | No |
| 6 | NCT01953302 | 2024 | Single-arm | 124 | Ventral/incisional | Modified open intraperitoneal mesh (sac preservation) | Yes |
| 7 | NCT03490266 | 2022 | RCT, double-blind | 150 | Ventral | Robotic vs. laparoscopic repair | No |
| 8 | NCT05591482 | 2022 | Retrospective cohort | 185 | Traumatic diaphragmatic | Suture vs. mesh, trans-abdominal open repair | No |
| 9 | NCT06298500 | 2025 | Retrospective observational | 443 | Inguinal | Histoacryl Lapfix tissue adhesive for laparoscopic mesh fixation | No |
| 10 | NCT05094089 | 2026 | Observational | 320 | Ventral/incisional | GORE SYNECOR biomaterial mesh, multi-center, 60-month follow-up | Pending |
Key Findings
Only 1 of 10 trials (NCT01953302) posted actual results. Its findings:
- Modified open intraperitoneal mesh with sac preservation technique for ventral hernia repair: 74% of 124 patients had no early complications and 91% had no recurrence at 36 months - a promising early result, though it is a single-arm (non-comparative) study, limiting conclusions about superiority over other techniques.
Evidence Gaps
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No comparative results are available from any of the randomized controlled trials in this set. This is a major evidence gap - several well-designed RCTs (e.g., the 398-participant Lichtenstein vs. ProGrip trial, the 150-participant robotic vs. laparoscopic trial) have completed enrollment but have not published results on ClinicalTrials.gov. The Lichtenstein/ProGrip trial (NCT01026935) does reference a separately published paper from 2012.
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Hernia type heterogeneity: The 10 trials cover at least five distinct hernia categories - ventral, inguinal (adult and pediatric), parastomal, strangulated, and traumatic diaphragmatic - making cross-trial synthesis unreliable.
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Recurrence rate is the most common primary outcome across trials, though follow-up periods vary (1 year to 60 months).
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Mesh fixation methods are a recurring theme: suture vs. self-fixating mesh (ProGrip), tissue adhesive (Histoacryl), retromuscular vs. preperitoneal placement.
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Minimally invasive vs. open approaches appear in multiple trials (laparoscopic TEP, robotic, laparoscopic), reflecting the ongoing transition in surgical practice - but no results yet.
Interpretation
The overwhelming limitation of this evidence set is publication/results reporting lag: 9 of 10 trials have not posted results to ClinicalTrials.gov, even where enrollment is listed as complete. This is a known systemic problem in clinical trial reporting. Any meaningful synthesis of comparative effectiveness across hernia repair techniques requires accessing the primary published literature (journals, not just registry records). The one trial with posted results (NCT01953302) suggests the modified sac-preserving intraperitoneal mesh approach is safe and durable at 3 years, but this needs confirmation in a comparative design.
Find recent hernia repair guidelines or systematic reviews on mesh techniques
Searching PubMed
"hernia repair" AND "mesh" AND "guidelines"
Searching PubMed
"inguinal hernia" AND "mesh repair" AND "systematic review"
Searching PubMed
"ventral hernia" AND "mesh" AND "repair"
Searching the Web
hernia repair mesh guidelines 2024 2025 EHS HerniaSurge systematic review
Reading Article
PMID: 35811449
Reading Article
PMID: 37542774
Reading Article
PMID: 40671180
Reading Article
PMID: 41913356
Reading Article
PMID: 38009575
Reading Article
PMID: 41396324
Here is a comprehensive synthesis of the most recent hernia repair guidelines and systematic reviews, organized by hernia type and clinical question.
Recent Hernia Repair Guidelines & Systematic Reviews on Mesh Techniques (2022-2026)
1. Mesh Fixation in Inguinal Hernia Repair
Umbrella review (BJS Open, 2022) - Techapongsatorn et al. (PMID 35811449) synthesized 30 prior systematic reviews and meta-analyses covering both open and laparoscopic inguinal repair. Key findings:
- Glue fixation (vs. suture in open repair, vs. tack in laparoscopic repair) is significantly associated with lower chronic groin pain - this is the strongest evidence to support glue use
- Self-gripping mesh (ProGrip) reduces operating time by a few minutes vs. sutured mesh, but the clinical significance is modest (0.36-7.85 min)
- Effects of glue on hernia recurrence were inconclusive for both open and laparoscopic approaches
Glue vs. suture in Lichtenstein repair - Phoa et al. (Hernia, 2022, PMID 35113292): Glue fixation is non-inferior to suture for recurrence and is associated with less chronic pain in open Lichtenstein repair.
Chronic groin pain - Lillo-Albert et al. (Hernia, 2024, PMID 38837072): Laparo-endoscopic approaches (TEP/TAPP) produce significantly less chronic inguinal pain post-hernioplasty compared to Lichtenstein open mesh repair.
2. Mesh vs. No Mesh in Emergency Groin Hernia Repair
Cochrane Review (2023) - Saeter et al. (PMID 38009575) - 15 RCTs, 1,241 participants:
- The evidence comparing mesh vs. non-mesh in emergency groin hernia repair is very low certainty overall
- Mesh may slightly increase 30-day surgical site infection risk (RR 1.66, 95% CI 0.96-2.88), but this is uncertain
- No 30-day recurrences recorded; mesh reduces long-term recurrence
- Conclusion: net benefit of mesh use in emergency setting is unclear, especially in contaminated fields
EAST Practice Management Guideline (J Trauma, 2025) - Farrell et al. (PMID 40671180) - 34 studies, GRADE methodology:
- Conditional recommendation for early surgery (<6 hours) - associated with lower bowel resection rates (OR 0.10, p<0.0001)
- Conditional recommendation for mesh repair over tissue repair - lower recurrence (OR 0.34, p=0.02) with mixed SSI results
- Conditional recommendation for laparoscopic over open - lower recurrence (OR 0.75, p=0.03), shorter hospital stay
- Note: evidence quality is very low (mostly retrospective data)
3. Mesh Type in Ventral Hernia Repair
Biologic vs. Synthetic Mesh - Siddiqui et al. (J Surg Res, 2023, PMID 37542774) - 4 RCTs, 758 patients:
- This meta-analysis directly challenges the conventional surgical teaching that biologic mesh is superior in contaminated fields
- Synthetic mesh had lower major complications (23.4% vs. 38.6%; RR 0.55, 95% CI 0.35-0.86, p=0.009)
- Synthetic mesh had lower recurrence rates (10.3% vs. 24.5%; RR 0.44, 95% CI 0.28-0.69, p=0.004)
- Lower SSI and reoperation rates also favored synthetic mesh
- Bottom line: Permanent synthetic mesh in contaminated fields may be as safe or better than biologic mesh - a practice-changing finding
Heavyweight vs. non-heavyweight mesh in ventral hernia - Trindade et al. (Hernia, 2024, PMID 37646880): No definitive superiority established for heavyweight mesh.
4. Fascial Defect Closure in Laparoscopic Ventral Hernia Repair
Hwessa et al. (World J Surg, 2026, PMID 41913356) - 5 RCTs, 549 patients (most recent, data to Sept 2025):
- Intraperitoneal underlay mesh with fascial defect closure (IPUM+) vs. bridged repair (IPUM alone)
- No significant difference in recurrence (RR 0.82, p=0.70), seroma (RR 0.78, p=0.58), operating time, or pain scores
- This contradicts prior observational data suggesting closure reduces recurrence and seroma - though the trial quality remains limited
5. Parastomal Hernia Repair
Bayesian Network Meta-Analysis (Hernia, 2025, PMID 41396324) - 28 studies, 1,983 patients - directly relevant to the NCT06474403 trial in your Elicit dataset:
- FunnelMesh ranked best for recurrence reduction (SUCRA 91.55%) - significantly better than Keyhole (OR 0.06) and suture repair (OR 0.11)
- Sandwich technique ranked second for recurrence prevention
- Modified Keyhole was safest for complications (SUCRA 91%), with lower complication risk than Sugarbaker or standard Keyhole
- Traditional Keyhole consistently shows high failure rates - guidelines advise against its use
- FunnelMesh showed some inconsistency in node-splitting, warranting cautious interpretation
6. EHS 2025 Emergency Guideline (Ventral/Incisional Hernias)
The European Hernia Society published new guidelines in 2025-2026 on emergency ventral and incisional hernia management, developed via GRADE methodology with face-to-face meetings (October 2024, January 2025 Genoa, March 2025 online) and presented at the EHS annual conference in Paris, June 2025. Key question addressed: mesh vs. tissue repair in emergency primary ventral/incisional hernia in stable patients with defects amenable to direct closure. Full text available at Frontiers Partnerships (EHS Guidelines).
Summary Table of Key Recommendations
| Clinical Scenario | Recommendation | Evidence Level |
|---|---|---|
| Inguinal hernia - mesh fixation in open repair | Glue preferred over suture to reduce chronic pain | Moderate |
| Inguinal hernia - approach | Laparo-endoscopic (TEP/TAPP) reduces chronic pain vs. Lichtenstein | Moderate |
| Emergency inguinal hernia | Early surgery (<6 h); mesh preferred; laparoscopic if feasible | Very low - conditional |
| Emergency groin hernia - mesh vs. no mesh | Cochrane: very uncertain; long-term recurrence favors mesh | Very low |
| Ventral hernia - biologic vs. synthetic mesh | Synthetic mesh non-inferior or superior even in contaminated fields | Low-moderate |
| Ventral hernia - fascial defect closure | No difference vs. bridged repair in laparoscopic repair | Low |
| Parastomal hernia | FunnelMesh/Sandwich for recurrence; Modified Keyhole for safety; avoid traditional Keyhole | Low-moderate |
Connection to Your Elicit Trials
Several of these evidence streams directly bear on the trials in your CSV:
- The EAST 2025 guideline (PMID 40671180) provides external context for NCT01411397 (strangulated hernias with mesh hernioplasty)
- The parastomal NMA (PMID 41396324) contextualizes NCT06474403 (laparoscopic TEP Sugabecker modification) - FunnelMesh and Sandwich dominate, while the Sugarbaker technique sits in the middle tier
- The biologic vs. synthetic meta-analysis (PMID 37542774) is relevant to NCT05094089 (GORE SYNECOR biomaterial evaluation) - synthetic meshes appear to hold up even in high-risk cases
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