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Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia

A Comment to this article was published on 04 August 2015

Abstract

Context

The utility of laparoscopic repair in the treatment of incisional hernia repair is still contentious.

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.

Data sources

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 was performed using medical subject headings (MESH) “hernia,” “incisional,” “abdominal,” “randomized/randomised controlled trial,” “abdominal wall hernia,” “laparoscopic repair,” “open repair”, “human” and “English”.

Study eligibility criteria, participants and interventions

Prospective RCTs comparing surgical treatment of only incisional hernia (and not primary ventral hernias) using open and laparoscopic methods were selected.

Study appraisal and synthesis methods

Data extraction and critical appraisal were carried out independently by two authors (AA and MAM) using predefined data fields. 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) postoperative neuralgia. These outcomes were unanimously decided to be important since they influence the practical and surgical approach towards hernia management within hospitals and institutions. 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 I 2 index. The meta-analysis was prepared in accordance with PRISMA guidelines.

Results

Sufficient data were available for the analysis of twelve clinically relevant outcomes. 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.

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Acknowledgments

We gratefully acknowledge and thank MJB for presenting the abstract of this paper at The Royal Australasian College of Surgeons Annual Scientific Congress, Sands Expo and Convention Centre, Marina Bay Sands, Singapore in 2014. The citation for published abstract is “ANZ Journal of Surgery 2014; 84 (Suppl 1): 67”.

Conflict of interest

AA, FR, MBH, RMY, SK, BM and MAM declare no conflict of interest.

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Correspondence to M. A. Memon.

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Awaiz, A., Rahman, F., Hossain, M.B. et al. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 19, 449–463 (2015). https://doi.org/10.1007/s10029-015-1351-z

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Keywords

  • Hernia
  • Incisional
  • Abdomen
  • Abdominal wall
  • Abdominal wall surgery
  • Hernia surgery
  • Randomized controlled trials
  • Open methods
  • Laparoscopic methods