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

Data de publicação:

Autores da FMUP

  • Hugo Miguel Teixeira Ferraz Santos Sousa

    Autor

  • Laura Elisabete Ribeiro Barbosa

    Autor

  • Bernardo Manuel De Sousa Pinto

    Autor

Participantes de fora da FMUP

  • Martins, Marcia Regina
  • do Vale, Miguel Alves
  • Bouca-Machado, Raquel

Unidades de investigação

Abstract

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.

Dados da publicação

ISSN/ISSNe:
1435-2451, 1435-2443

LANGENBECKS ARCHIVES OF SURGERY  Springer Verlag

Tipo:
Article
Páginas:
-
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 1

Citações Recebidas na Scopus: 1

Documentos

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Keywords

  • Ventral hernia; Umbilical hernia; Paraumbilical hernia; Epigastric hernia; Laparoscopic repair; Open repair

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