Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis
One standard repair technique for groin hernias does not exist. The objective of this study is to perform an update meta-analysis and trial sequential analysis to investigate if there is a difference in terms of recurrence between laparoscopic and open primary unilateral uncomplicated inguinal hernia repair.
The reporting methodology conforms to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Randomised controlled trials only were included. The intervention was laparoscopic mesh repair (transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)). The control group was Lichtenstein repair. The primary outcome was recurrence rate and secondary outcomes were acute and chronic post-operative pain, morbidity and quality of life.
This study included 12 randomised controlled trials with 3966 patients randomised to Lichtenstein repair (n = 1926) or laparoscopic repair (n = 2040). There were no significant differences in recurrence rates between the laparoscopic and open groups (odds ratio (OR) 1.14, 95% CI 0.51–2.55, p = 0.76). Laparoscopic repair was associated with reduced rate of acute pain compared to open repair (mean difference 1.19, CI − 1.86, − 0.51, p ≤ 0.0006) and reduced odds of chronic pain compared to open (OR 0.41, CI 0.30–0.56, p ≤ 0.00001). The included trials were, however, of variable methodological quality. Trial sequential analysis reported that further studies are unlikely to demonstrate a statistically significant difference between the two techniques.
This meta-analysis and trial sequential analysis report no difference in recurrence rates between laparoscopic and open primary unilateral inguinal hernia repairs. Rates of acute and chronic pain are significantly less in the laparoscopic group.
KeywordsInguinal hernia Lichtenstein TAPP TEP
There were no sources of funding associated with this review.
Compliance with ethical standards
Conflict of interest
NLB, LHM, SAA, NJS and RHF declare no conflict of interest.
Approval from the institutional review board was not required for this study.
Human and animal rights
This article is a systematic review and meta-analysis and it contains data collected through literature review. It does not include research directly involving human or animal participation.
For this literature review, formal consent is not required.
- 3.Simons MP, Aufenacker TJ, Berrevoet F, Bingener J, Bisgaard T, Bittner R, Bonjer HJ, Bury K, Campanelli G, Chen DC, Chowbey PK (2017) World guidelines for groin hernia management. http://news.europeanherniasociety.eu/sites/www.europeanherniasociety.eu/files/medias/PDF/HerniaSurgeGuidelinesPART1TREATMENT.pdf. Accessed 1 Apr 2019
- 8.Scheuermann U, Niebisch S, Lyros O, Jansen-Winkeln B, Gockel I (2017) Transabdominal Preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials. BMC Surg 17(1):55CrossRefPubMedPubMedCentralGoogle Scholar
- 11.University of York, Centre for Reviews and Dissemination. PROSPERO; International prospective register of systematic reviews. http://www.crd.york.ac.uk/PROSPERO. Accessed 1 Apr 2019
- 12.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 health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, Di Miceli D, Doglietto GB (2011) International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 15:239. https://doi.org/10.1007/s10029-011-0798-9 CrossRefGoogle Scholar
- 16.Higgins JPT, Deeks JJ (2011) Obtaining standard deviations from standard errors, confidence intervals, t values and p values for differences in means. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. https://handbook-5-1.cochrane.org/. Accessed 1 Apr 2019
- 19.Higgins JP, Altman DG (2009) Assessing risk of bias in included studies. In: Higgins JP, Green S (eds) Cochrane handbook for systematic reviews of interventions. Wiley, West Sussex, pp 187–235Google Scholar
- 29.Eklund A, Rudberg C, Smedberg S, Enander LK, Leijonmarck CE, Österberg J, Montgomery A (2006) Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg: Inc Eur J Surg Swiss Surg 93(9):1060–1068CrossRefGoogle Scholar
- 30.Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, Steiner E, Pernthaler H, Függer R, Scheyer M (2008) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12(4):385–389CrossRefGoogle Scholar
- 40.http://www.rcseng.ac.uk/commisioning/groin-hernia-commissioning-guide. Accessed 1 May 2019
- 41.https://www.precis-2.org/. Accessed 1 May 2019
- 47.Gohel MS, Chetter I. Are clinical trials units essential for a successful trial?. Bmj. 2015 May 27;350:h2823Google Scholar