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

Abstract

Background Ventral hernia repair has suffered various changes in the previous decade and new techniques have started to be used. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions and may reduce recurrence, pain, and hospital stay. However, whether the laparoscopic approach may improve clinical outcomes has not been systematically assessed. Objectives The aim of this systematic review is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias (epigastric, umbilical, and paraumbilical 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 the laparoscopic with the open approach in patients with a primary ventral hernia (epigastric, umbilical, and paraumbilical hernias) were included. The quality of included studies was evaluated according to the Cochrane risk of bias tool. A random effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for standardized mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Heterogeneity being assessed by I2 statistic. Results A total of nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in the laparoscopic approach (RR=0.49; 95%CI=0.27-0.89; p=0.020; I2=29%). Local infection (RR=0.32; 95%CI=0.20-0.51; p<0.001; I2=0%), wound dehiscence (RR=0.08; 95%CI=0.02-0.34; p<0.001; I2=0%) and local seroma (RR=0.43; 95%CI=0.22-0.86; p=0.020; I2=14%) were also significantly less likely to be present in patients undergoing laparoscopic surgery. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work. Discussion Results should be analyzed cautiously given the detected heterogeneity and the limitations of included primary studies. Nevertheless, the laparoscopic approach of the primary ventral hernia repair appeared to be associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.