Analysing the benefits of laparoscopic hernia repair compared to open repair: A meta-analysis of observational studies

Abstract

BACKGROUND:The purpose of this study is to compare the difference of incidence of post-operative complications, operative time, length of stay and recurrence of patients undergoing laparoscopic or open repair of their ventral/incisional hernia a meta-analytic technique for observational studies.MATERIALS AND METHODS:A literature search was performed using Medline, PubMed, Embase and Cochrane databases for studies reported between 1998 and 2009 comparing laparoscopic and open surgery for the treatment of ventral (incisional) hernia. This meta-analysis of all the observational studies compared the post-operative complications recurrence rate and length of stay. The random effects model was used. Sensitivity and heterogeneity were analysed.RESULTS:Analysis of 15 observational studies comprising 2452 patients qualified for meta-analysis according to the study's inclusion criteria. Laparoscopic surgery was attempted in 1067 out of 2452. The results showed that the length of stay (odds ratio [OR], – 1.00; 95% confidence interval [CI], – 1.09 to – 0.91; P < 0.00001) and operative time (OR, 59.33; 95% CI, 58.55 to 60.11; P < 0.00001) was significantly lower in the laparoscopic group. The results also showed that there was a significant reduction in the formation of abscesses (OR, 0.38; 95% CI, 0.16 to 0.92; P = 0.03) and wound infections (OR, 0.49; 95% CI, 0.29 to 0.82; P = 0.007) post-operatively. There is a trend which indicates that the recurrence of the hernia using laparoscopic repair versus open repair was overall lower with the laparoscopic repair (OR, 0.48; 95% CI, 0.22 to 1.04; P = 0.06), however, this was not significant.CONCLUSION:Laparoscopic incisional hernia repair was associated with a reduced length of stay, operative time and lower incidence of abscess and wound infection post-operatively. This study also highlights the benefit of using observational studies as a form of research and its value as a tool in answering questions where large sample sizes of patient groups would be impossible to accumulate in a reasonable length of time.

Surgery-related complications of ventral hernia reported to the Finnish Patient Insurance Centre

“…In several studies comparing results of open and laparoscopic operations, it has been shown that the time of hospital stay is shorter, postoperative recovery is faster, and the overall complication rate is lower in laparoscopic procedures (10%-32% vs 29%-48%) (6,(9)(10)(11). Furthermore, the incidence of hernia recurrence may be lower after laparoscopic operations though comparative studies have not reached statistically significant differences (2,12,13). Overall, incisional hernioplasties carry a morbidity of about 23% (14) and mortality of 0.05% (15).…”

Açık ve laparoskopik insizyonel herni onarımının ağrı skorları ve hasta memnuniyeti açısından karşılaştırılması

“…However Earle et al found that laparoscopic repair does not increase cost to the health care system in overall looking (17). Recently, laparoscopic and open hernia repair was compared by meta-analysis (16)(17)(18)(19). Al Chalabi et al in 2015 published a meta-analysis of 5 randomized controlled trials with a total of 611 patients and found laparoscopic repair to be associated with less wound infection (only wound infection rate (p<0.001) was statistically different), shorter hospital stay but longer operation time (16).…”

Indikationen zur laparoskopischen Versorgung großer Narbenhernien

“…Die Vorteile der Laparoskopie im Sinne der Minimierung des operativen Traumas wurden für das Lap.-IPOM mehrfach demonstriert [14,15,18,19,20 Abb. 1 8 Narbenhernienbefunde, die als positive und negative Einflussgrößen auf die Rezidivprognose im Fall der laparoskopischen IPOM-Versorgung großer Narbenhernien angenommen werden können (schematische Darstellungen realer Patienten aus dem Jahr 2013).…”

“…Tab. 1, [11,17,18,20]). Dass Komplikationen nach laparoskopischen Eingriffen schwerwiegender sind als bei offenen Rekonstruktionen gehört in die Zeit der Anfangsjahre, obwohl potenziell übersehene Darmläsionen im Rahmen der Adhäsiolyse eine ständige Gefahr darstellen [31].…”

“…Dass Komplikationen nach laparoskopischen Eingriffen schwerwiegender sind als bei offenen Rekonstruktionen gehört in die Zeit der Anfangsjahre, obwohl potenziell übersehene Darmläsionen im Rahmen der Adhäsiolyse eine ständige Gefahr darstellen [31]. Netzinfektionen sind nach offenen Verfahren sogar häufiger als nach laparoskopischen und für Patient und Chirurg eine nicht unerhebliche Belastung [32] [18].…”