Laparoscopic versus open umbilical or paraumbilical hernia repair: a systematic review and meta-analysis
To compare outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias.
We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (Registration Number: CRD42016052131). We conducted a search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists to identify all randomised controlled trials (RCTs) and observational studies comparing outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. We used the Cochrane risk of bias tool and the Newcastle–Ottawa scale to assess the risk of bias of RCTs and observational studies, respectively. Random effects models were applied to calculate pooled outcome data.
We identified three RCTs and seven retrospective cohort studies, enrolling a total of 16,549 patients. Our analyses indicated that open repair was associated with a higher risk of wound infection [Odds ratio (OR) 2.35, 95% CI 1.23–4.48, P = 0.010], wound dehiscence (OR 4.99, 95% CI 1.12–22.28, P = 0.04) and recurrence (OR 4.06, 95% CI 1.54–10.71, P = 0.005), longer length of hospital stay (MD 26.85, 95% CI 8.15–45.55, P = 0.005) and shorter operative time [Mean difference (MD) − 23.07, 95% CI − 36.78 to − 9.35, P = 0.0010] compared to laparoscopic repair. There was no difference in the risk of haematoma (OR 2.03, 95% CI 0.22–18.73, P = 0.53) or seroma (OR 0.67, 95% CI 0.19–2.32, P = 0.53) between the two groups.
The best available evidence (randomised and non-randomised studies) suggests that laparoscopic repair of umbilical or paraumbilical hernias may be associated with a lower risk of wound infection, wound dehiscence and recurrence rate, shorter length of stay but longer operative time. Results from a limited number of RCTs showed no difference in recurrence rates. The quality of the best available evidence is moderate, and selection bias is the major concern due to non-randomised design in most of the available studies. Therefore, considering the level of available evidence, the most reliable approach for repair of umbilical or paraumbilical hernia should be based on surgeon’s experience, clinical setting, patient’s age and size, hernia defect size and anatomical characteristics. High quality RCTs are required.
KeywordsUmbilical Paraumbilical Hernia Laparoscopy
Shahab H and Shahin H have equally contributed to this paper and a joined first authorship is proposed. Conception and design: Shahab H, Shahin H. Literature search and study selection: AS, Shahab H, Shahin H. Data collection: AS, Shahab H, Shahin H. Analysis and interpretation: Shahab H, Shahin H. Writing the article: Shahab H, Shahin H. Critical revision of the article: Shahab H, Shahin H, AS, AK, DS, LJ. Final approval of the article: Shahab H, Shahin H, AS, AK, DS, LJ. Statistical analysis: Shahab H, Shahin H.
Compliance with ethical standards
Conflict of interest
Shahab H declares no conflict of interest. Shahin H declares no conflict of interest. AS declares no conflict of interest. AK declares no conflict of interest. DS declares no conflict of interest. LJ declares no conflict of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
This article does not include patients, and therefore informed consent was not applicable.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
- 9.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 15 May 2014
- 11.Higgins JP, Altman DG, editors. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.0.1 (updated September 2008). http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ch08_Bias.pdf. Accessed 15 May 2016