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Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis
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Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis
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Journal Article
Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis
2016
Overview
Background
Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence.
Methods
A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI).
Results
24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD −0.06, 95 % CI [−0.09, −0.03],
p
= 0.0002,
I
2
= 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD −0.14, 95 % CI [−0.22, −0.06],
p
= 0.001,
I
2
= 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD −0.01, 95 % CI [−0.03, 0.01],
p
= 0.31,
I
2
= 35 %). Wound infections were significantly reduced in the laparoscopic group (RD −0.06, 95 % CI [−0.09, −0.03],
p
< 0.0001,
I
2
= 35 %); overall postoperative morbidity was comparable in both groups (RD −0.06, 95 % CI [−0.13, 0.00],
p
= 0.06;
I
2
= 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD −1.92, 95 % CI [−2.67, −1.17],
p
< 0.00001,
I
2
= 87 %). At short-term follow-up, quality of life was in favor of laparoscopy.
Conclusions
Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.
Publisher
Springer International Publishing,John Wiley & Sons, Inc
