, Volume 21, Issue 6, pp 905–916 | Cite as

Laparoscopic versus open umbilical or paraumbilical hernia repair: a systematic review and meta-analysis

  • S. Hajibandeh
  • S. Hajibandeh
  • A. Sreh
  • A. Khan
  • D. Subar
  • L. Jones



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;; 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.


Umbilical Paraumbilical Hernia Laparoscopy 


Author contributions

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.

Ethical approval

Not required.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

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.


  1. 1.
    Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20(12):1839–1845CrossRefPubMedGoogle Scholar
  2. 2.
    Mayo WJ (1901) An operation for the radical cure of umbilical hernia. Ann Surg 34:276–280CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kulaçoğlu H (2015) Current options in umbilical hernia repair in adult patients. Ulus Cerrahi Derg 31(3):157–161PubMedPubMedCentralGoogle Scholar
  4. 4.
    Gray SH, Hawn MT, Itani KMF (2008) Surgical progress in inguinal and ventral incisional hernia repair. Surg Clin N Am 88:17–26CrossRefPubMedGoogle Scholar
  5. 5.
    Arroyo A, Garcia P, Perez F, Andreu J, Candela F, Calpena R (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg 88:1321–1323CrossRefPubMedGoogle Scholar
  6. 6.
    McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SR, Laycock WS, Birkmeyer JD (2003) A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 17(11):1778–1780CrossRefPubMedGoogle Scholar
  7. 7.
    Jaqab RB (2008) Laparoscopic ventral hernia repair: a new method for fixation of the mesh with sutures. Surg Laparosc Endosc Percutan Tech 18:277–279CrossRefGoogle Scholar
  8. 8.
    Muqim R, Jan QE, Zarin M, Khan MT, Iqbal J, Khan IN et al (2008) Laparoscopic repair of ventral hernia, an early experience at Khyber teaching hospital, Peshawar. World J Laparosc Surg 1:35–38CrossRefGoogle Scholar
  9. 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. 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. Accessed 15 May 2014
  11. 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). Accessed 15 May 2016
  12. 12.
    Purushotham B, Madhu S (2015) Comparative study between laparoscopic and open repair of umbilical and para umbilical hernia. Int Surg J 2(2):204–213CrossRefGoogle Scholar
  13. 13.
    Malik AM (2015) Laparoscopic versus open repair of paraumbilical hernia. Is it a good alternative? J Pak Med Assoc 65(8):865–868PubMedGoogle Scholar
  14. 14.
    Othman IH, Metwally YH, Bakr IS, Amer YA, Gaber MB, Elgohary SA (2012) Comparative study between laparoscopic and open repair of paraumbilical hernia. J Egypt Soc Parasitol 42(1):175–182CrossRefPubMedGoogle Scholar
  15. 15.
    Cassie S, Okrainec A, Saleh F, Quereshy FS, Jackson TD (2014) Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc 28(3):741–746CrossRefPubMedGoogle Scholar
  16. 16.
    Colon MJ, Kitamura R, Telem DA, Nguyen S, Divino CM (2013) Laparoscopic umbilical hernia repair is the preferred approach in obese patients. Am J Surg 205(2):231–236CrossRefPubMedGoogle Scholar
  17. 17.
    Shaikh I, Willder JM, Kumar S (2013) Same day discharge, surgical training and early complications after open and laparoscopic repair of primary paraumbilical hernia. Hernia 17(4):505–509CrossRefPubMedGoogle Scholar
  18. 18.
    Solomon TA, Wignesvaran P, Chaudry MA, Tutton MG (2010) A retrospective audit comparing outcomes of open versus laparoscopic repair of umbilical/paraumbilical herniae. Surg Endosc 24(12):3109–3112CrossRefPubMedGoogle Scholar
  19. 19.
    Lau H, Patil NG (2003) Umbilical hernia in adults. Surg Endosc 17(12):2016–2020CrossRefPubMedGoogle Scholar
  20. 20.
    Gonzalez R, Mason E, Duncan T, Wilson R, Ramshaw BJ (2003) Laparoscopic versus open umbilical hernia repair. JSLS. 7(4):323–328PubMedPubMedCentralGoogle Scholar
  21. 21.
    Wright BE, Beckerman J, Cohen M, Cumming JK, Rodriguez JL (2002) Is laparoscopic umbilical hernia repair with mesh a reasonable alternative to conventional repair? Am J Surg 184(6):505–508 (discussion 508-509) CrossRefPubMedGoogle Scholar
  22. 22.
    Zhang Y, Zhou H, Chai Y, Cao C, Jin K, Hu Z (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38(9):2233–2240CrossRefPubMedGoogle Scholar
  23. 23.
    Al Chalabi H, Larkin J, Mehigan B, McCormick P (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg 20:65–74CrossRefPubMedGoogle Scholar
  24. 24.
    Marusch F, Gastinger I, Schneider C et al (2001) Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 44:207–214CrossRefPubMedGoogle Scholar
  25. 25.
    Belizon A, Sardinha CT, Sher ME (2006) Converted laparoscopic colectomy: what are the consequences? Surg Endosc 20:947–951CrossRefPubMedGoogle Scholar
  26. 26.
    Gupta A, Watson DI (2001) Effect of laparoscopy on immune function. Br J Surg 88:1296–1306CrossRefPubMedGoogle Scholar
  27. 27.
    Wichman MW, Hüttl TP, Winter H et al (2005) Immunological effects of laparoscopic vs open colorectal surgery. Arch Surg 140:692–697CrossRefGoogle Scholar
  28. 28.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias. Nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400PubMedPubMedCentralGoogle Scholar
  29. 29.
    Rudmik LR, Schieman C, Dixon E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10:110–119CrossRefPubMedGoogle Scholar
  30. 30.
    Perrone JM, Soper NJ, Eagon JC et al (2005) Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery 138:708–715 (discussion 715–716) CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  • S. Hajibandeh
    • 1
    • 3
  • S. Hajibandeh
    • 2
    • 3
  • A. Sreh
    • 3
  • A. Khan
    • 3
  • D. Subar
    • 3
  • L. Jones
    • 3
  1. 1.Department of General SurgerySalford Royal HospitalSalfordUK
  2. 2.Department of General SurgeryNorth Manchester General HospitalManchesterUK
  3. 3.Department of General SurgeryRoyal Blackburn HospitalBlackburnUK

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