Comparative efficacy and safety of surgical techniques for inguinal hernia repair in elderly patients: a network meta-analysis

Objective The optimal surgical technique for elderly patients (≥60 years) with inguinal hernia remains uncertain. This study compared the efficacy and safety of various techniques using network meta-analysis. Methods PubMed, Embase, Cochrane Library, and Wanfang databases were searched through February 2025 for randomized controlled trials comparing inguinal hernia repair techniques in elderly patients. Outcomes included perioperative indexes and postoperative complications. Analyses were conducted using R. Results Twenty-eight trials (3184 patients; reported mean or median age 62–76 years, predominantly male) were included. The overall risk of bias was judged low in 10 trials, with some concerns in 8 trials and high in 10 trials. The network was well-connected across multiple techniques. Laparoscopic approaches showed advantages in several perioperative outcomes. LR-TEP yielded the least bleeding (vs. OMR-CSR: SMD=−15.18, 95% CI: −23.45 to −6.90) and shortest hospital stay (SMD=−2.30, 95% CI: −3.57 to −1.03), ranking highest for both (SUCRA ≈0.84 and 0.97, respectively). LR-TAPP also reduced bleeding (SMD=−12.34, 95% CI: −24.27 to −0.41) and stay (SMD=−1.81, 95% CI: −3.30 to −0.33). LR-TEP enabled the earliest ambulation (SMD=−18.66, 95% CI: −25.61 to −11.71; SUCRA ≈0.955). Recurrence rates were similar except for OMR-Lightweight, which had a higher risk (RR = 26.16, 95% CI: 1.07–639.67). OMR-PHS had the best safety profile (RR = 0.04, 95% CI: 0.00–0.65). LR-TEP and LR-TAPP significantly reduced complications (RR = 0.28 and 0.33, respectively). IPOM provided the greatest pain relief (SMD=−2.65, 95% CI: −4.58 to −0.73). Urinary retention incidence was low, with no significant between-technique differences. Conclusions Minimally invasive repairs, particularly LR-TEP, appear to offer favorable short-term recovery outcomes in appropriately selected elderly inguinal hernia patients, with comparable recurrence rates to open techniques. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251124772 , identifier PROSPERO 2025 CRD420251124772.