Laparoscopic vs open repair for incisional hernia

Laparoscopic vs open repair for incisional hernia

OBJECTIVES: The aim was to conduct a meta-analysis of RCTs investigating the surgical and postsurgical outcomes of elective incisional hernia by open versus laparoscopic method.

MATERIAL AND METHODS: A search of PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1993 and September 2013 identified all the prospective RCTs comparing surgical treatment of only incisional hernia (and not primary ventral hernias) using open and laparoscopic methods were selected. The outcome variables analyzed included (a) hernia diameter; (b) operative time; (c) length of hospital stay; (d) overall complication rate; (e) bowel complications; (f) reoperation; (g) wound infection; (h) wound hematoma or seroma; (i) time to oral intake; (j) back to work; (k) recurrence rate; and (l) post-operative neuralgia. The quality of RCTs was assessed using Jadad's scoring system. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity amongst the outcome variables of these trials was determined by the Cochran Q statistic and I2 index. The meta-analysis was prepared in accordance with PRISMA guidelines.

RESULTS: Six RCTs were considered suitable for meta-analysis. A total of 378 patients underwent open mesh repair and 373 had laparoscopic repair. Statistically significant reduction in bowel complications was noted with open surgery compared to the laparoscopic repair in five studies (OR 2.56, 95% CI 1.15, 5.72, p=0.02). Comparable effects were noted for other variables which include hernia diameter (SMD -0.27, 95% CI -0.77, 0.23, p=0.29), operative time (SMD -0.08, 95% CI -4.46, 4.30, p=0.97), overall complications (OR -1.07, 95% CI -0.33, 3.42, p=0.91), wound infection (OR 0.49, 95% CI 0.09, 2.67, p=0.41), wound hematoma or seroma (OR 1.54, 95% CI 0.58, 4.09, p=0.38), reoperation rate (OR -0.32, 95% CI 0.07, 1.43, p=0.14), time to oral intake (SMD -0.16, 95% CI -1.97, 2.28, p=0.89), length of hospital stay (SMD -0.83, 95% CI -2.22, 0.56, p=0.24), back to work (SMD -3.14, 95% CI -8.92, 2.64, p=0.29), recurrence rate (OR 1.41, 95% CI 0.81, 2.46, p=0.23), and postoperative neuralgia (OR 0.48, 95% CI 0.16, 1.46, p=0.20).

CONCLUSIONS: On the basis of our meta-analysis, we conclude that laparoscopic and open repair of incisional hernia is comparable. A larger randomized controlled multicenter trial with strict inclusion and exclusion criteria and standardized techniques for both repairs is required to demonstrate the superiority of one technique over the other.