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Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis

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Abstract

Background

Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence.

Methods

A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI).

Results

24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD −0.06, 95 % CI [−0.09, −0.03], p = 0.0002, I 2 = 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD −0.14, 95 % CI [−0.22, −0.06], p = 0.001, I 2 = 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD −0.01, 95 % CI [−0.03, 0.01], p = 0.31, I 2 = 35 %). Wound infections were significantly reduced in the laparoscopic group (RD −0.06, 95 % CI [−0.09, −0.03], p < 0.0001, I 2 = 35 %); overall postoperative morbidity was comparable in both groups (RD −0.06, 95 % CI [−0.13, 0.00], p = 0.06; I 2 = 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD −1.92, 95 % CI [−2.67, −1.17], p < 0.00001, I 2 = 87 %). At short-term follow-up, quality of life was in favor of laparoscopy.

Conclusions

Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.

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Abbreviations

MH:

Mantel–Haenszel method

IV:

Inverse variance method

RCT:

Randomized controlled trial

OP:

Open abdominal surgery

CI:

Confidence interval

NNT:

Number needed to treat

LAP:

Laparoscopy

RD:

Risk difference

MD:

Mean difference

I 2 :

Statistical heterogeneity

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Authors’ Contributions

J. K carried out the search, extracted the data, assessed the risk of bias, and drafted the manuscript. K. G carried out the search, performed the duplicate data extraction, assessed the risk of bias, and helped to draft the manuscript. K. J planned performed and interpreted the statistical analysis. M. D concepted, analyzed, and interpreted the study. F. H analyzed the data and was part of the writing committee. All other authors drafted the manuscript and helped to interpret the data.

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Authors and Affiliations

  1. Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Julia B. Kössler-Ebs, Felix J. Hüttner, Beat Müller-Stich, Phillip Knebel, Markus W. Büchler & Markus K. Diener

  2. Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Julia B. Kössler-Ebs, Kathrin Grummich, Felix J. Hüttner, Phillip Knebel & Markus K. Diener

  3. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Katrin Jensen

  4. Josephs-Hospital Warendorf, General-, Visceral- and Vascular Surgery, Am Krankenhaus 2, 48231, Warendorf, Germany

    Christoph M. Seiler

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  1. Julia B. Kössler-Ebs
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Correspondence to Markus K. Diener.

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Kössler-Ebs, J.B., Grummich, K., Jensen, K. et al. Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis. World J Surg 40, 2319–2330 (2016). https://doi.org/10.1007/s00268-016-3520-3

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