Comparison between the open and the laparoscopic approach in the primary ventral hernia repair: a systematic review and meta-analysis

• Type: Article in International Scientific Journal
• Date: 2024

Authors

Martins, MR (Author) Other; Santos-Sousa, H (Author) Other; do Vale, MA (Author) Other; Bouça-Machado, R (Author) Other; Barbosa, E (Author) Other; Sousa-Pinto, B (Author) FMUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: LANGENBECKS ARCHIVES OF SURGERY

Vol. 409

ISSN: 1435-2443

Publisher: Springer

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Other information

Authenticus ID: P-00Z-WZM

DOI: 10.1007/s00423-024-03241-y

Abstract (EN): Background Ventral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed. ObjectivesThe aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias. Methods A systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Results Nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32-0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19-0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02-0.32; p < 0.001; I-2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19-0.59; p < 0.001; I-2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Conclusion The results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 14