Surgical Endoscopy

, Volume 21, Issue 3, pp 378–386 | Cite as

Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual

  • Richard A. Pierce
  • Jennifer A. Spitler
  • Margaret M. Frisella
  • Brent D. Matthews
  • L. Michael Brunt
Article

Abstract

Background

The purpose of this study was to analyze the published perioperative results and outcomes of laparoscopic (LVHR) and open (OVHR) ventral hernia repair focusing on complications and hernia recurrences.

Methods

Data were compiled from all English-language reports of LVHR published from 1996 through January 2006. Series with fewer than 20 cases of LVHR, insufficient details of complications, or those part of a larger series were excluded. Data were derived from 31 reports of LVHR alone (unpaired studies) and 14 that directly compared LVHR to OVHR (paired sudies). Chi-squared analysis, Fisher’s exact test, and two-tailed t-test analysis were used.

Results

Forty-five published series were included, representing 5340 patients (4582 LVHR, 758 OVHR). In the pooled analysis (combined paired and unpaired studies), LVHR was associated with significantly fewer wound complications (3.8% vs. 16.8%, p < 0.0001), total complications (22.7% vs. 41.7%, p < 0.0001), hernia recurrences (4.3% vs. 12.1%, p < 0.0001), and a shorter length of stay (2.4 vs. 4.3 days, p = 0.0004). These outcomes maintained statistical significance when only the paired studies were analyzed. In the pooled analysis, LVHR was associated with fewer gastrointestinal (2.6% vs. 5.9%, p < 0.0001), pulmonary (0.6% vs. 1.7%, p = 0.0013), and miscellaneous (0.7% vs. 1.9%, p = 0.0011) complications, but a higher incidence of prolonged procedure site pain (1.96% vs. 0.92%, p = 0.0469); none of these outcomes was significant in the paired study analysis. No differences in cardiac, neurologic, septic, genitourinary, or thromboembolic complications were found. The mortality rate was 0.13% with LVHR and 0.26% with OVHR (p = NS). Trends toward larger hernia defects and larger mesh sizes were observed for LVHR.

Conclusions

The published literature indicates fewer wound-related and overall complications and a lower rate of hernia recurrence for LVHR compared to OVHR. Further controlled trials are necessary to substantiate these findings and to assess the health care economic impact of this approach.

Keywords

Ventral hernia Incisional hernia Hernia repair Laparoscopy Meta-analysis Statistical analysis 

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Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Richard A. Pierce
    • 1
  • Jennifer A. Spitler
    • 1
  • Margaret M. Frisella
    • 1
  • Brent D. Matthews
    • 1
  • L. Michael Brunt
    • 1
  1. 1.Department of Surgery and Institute for Minimally Invasive SurgeryWashington University School of MedicineSt. LouisUSA

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