LAPAROSCOPY VERSUS LAPAROTOMY IN THE REPAIR OF VENTRAL HERNIAS: systematic review and meta-analysis

Abstract

-Objective -To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical time, and recurrence of hernia. Methods -This was a systematic review of randomized controlled trials, which included studies retrieved from four databases (MEDLINE, Embase, Cochrane and LILACS), using a combination of the terms (Hernia, Ventral) and (Laparoscopy) and (Laparotomy). Results -Six randomized trials were included, totaling 566 patients, 283 in the Laparoscopy group and 283 in the Laparotomy group. Laparoscopy reduced the risk of infection of the surgical wound (NNT = 5) and seroma formation (NNT = 13) and less length hospitalization (P = 0.02) compared to laparotomy in the correction of ventral hernias. Furthermore, laparoscopy increased the incidence of enterotomy (NNH = 25) and post operative pain (NNH = 8) and longer surgical time (P = 0.0009) when compared with laparotomy. There was no difference related to abscess (P = 0.79), hematoma (P = 0.43) and recurrency of ventral hernias (P = 0.25). Conclusion -In the correction of ventral hernias, the use of laparoscopic technique is effective to reduce infections of the surgical wound and seroma formation, as well as, decrease the length hospitalization. HEADINGS -Ventral hernia. Laparoscopy. Laparotomy. Review.

Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences

“…and more for SAWR [72,81,83,86,92,93], and of 4 and more for CAWR [75,[77][78][79]85,91,[94][95][96]. Values coming from mixed studies were not considered.…”

Current Trends in Laparoscopic Ventral Hernia Repair

“…The mesh is further secured with 5-mm titanium tacks, applied with a Protack device (Covidien, Mansfield, Massachusetts); with absorbable tacks, applied with the Absorbatack device (Covidien); with the SorbaFix (Bard Davol); or by using titanium clips (EMS; Ethicon). 40 , 41 A recently introduced fixation device, the Secure Strap (Ethicon) uses absorbable straps to fix the mesh, with promising results. 42 …”

Comparative study between laparoscopic and open repair of umbilical and para umbilical hernia

“…Patients with hernia of 1,4  Defects larger than 2 cm  And previous umbilical hernia repairs of any size benefit from the lap technique…”

“…William Mayo's in 1901 described the classical overlapping repair -vest over trousers in 19 patients. 4 The initial high recurrence rate -10-30% following suture repair has been brought down to <2% by the introduction of prosthetic mesh repair. Laparoscopic mesh repair is now being accepted as an effective alternative to open mesh repair of umbilical/paraumbilical Hernia.…”