Open versus laparoscopic incisional hernia repair: something different from a meta-analysis
- PMID: 18320281
- DOI: 10.1007/s00464-008-9773-7
Open versus laparoscopic incisional hernia repair: something different from a meta-analysis
Abstract
Background: Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare the available alloplastic materials and try to clarify the question of whether the laparoscopic procedure is superior to the conventional (open) technique based on the available randomized studies.
Methods: All available meshes for intraperitoneal and extraperitoneal implantation were described regarding their handling and their pros and cons. A database search (PubMed, Medline, Ovid, and in the secondary literature) was carried out to retrieve all randomized studies comparing laparoscopic and open hernia repair. Data were reviewed by two independent scientists for surgical and statistical design.
Results: The ideal mesh for a laparoscopic maintenance of abdominal wall hernias as well as the optimal fixation of the mesh has not been found yet. Recent available literature shows no evidence demonstrating the superiority of one of these meshes. The available studies found a lower infection rate, but higher occurrence of seroma for the laparoscopic procedure. The value of the different studies is reduced due to deficiency in study design and power. Guidelines for further studies are discussed to avoid surgical and statistical pitfalls.
Conclusions: Laparoscopic incisional hernia repair shows, in some (randomized) studies as well as a large number of retrospective analyses and in case control studies, superiority compared to conventional hernia repair. Long-term results with a high level of evidence are not available. Additional well-designed randomized trials including long-term observation of patients are required in order to clarify a number of interesting questions.
Similar articles
-
Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness.GMS Health Technol Assess. 2008 Mar 7;4:Doc01. GMS Health Technol Assess. 2008. PMID: 21289907 Free PMC article.
-
Comparison of Mesh Fixation Techniques in Elective Laparoscopic Repair of Incisional Hernia-ReliaTack™ v ProTack™ (TACKoMesh) - A double-blind randomised controlled trial.BMC Surg. 2018 Jul 11;18(1):46. doi: 10.1186/s12893-018-0378-3. BMC Surg. 2018. PMID: 29996841 Free PMC article. Clinical Trial.
-
Interposition of the omentum and/or the peritoneum in the emergency repair of large ventral hernias with polypropylene mesh.Int J Surg. 2014;12(6):578-86. doi: 10.1016/j.ijsu.2014.04.009. Epub 2014 Apr 30. Int J Surg. 2014. PMID: 24793234
-
Controversies in laparoscopic ventral hernia repair.Minerva Chir. 2015 Dec;70(6):481-92. Minerva Chir. 2015. PMID: 26657758 Review.
-
Seroma prevention strategies in laparoscopic ventral hernia repair: a systematic review.Hernia. 2020 Aug;24(4):717-731. doi: 10.1007/s10029-019-02098-1. Epub 2019 Nov 29. Hernia. 2020. PMID: 31784913
Cited by
-
Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair.Surg Endosc. 2012 May;26(5):1461-7. doi: 10.1007/s00464-011-2056-8. Epub 2011 Dec 15. Surg Endosc. 2012. PMID: 22170318
-
Differences of alternative methods of measuring abdominal wall hernia defect size: a prospective observational study.Surg Endosc. 2018 Mar;32(3):1228-1233. doi: 10.1007/s00464-017-5797-1. Epub 2017 Sep 15. Surg Endosc. 2018. PMID: 28917010
-
Laparoscopic Ventral Hernia Repair Combined with Sleeve Gastrectomy in Morbidly Obese Patients: Early Outcomes.Surg J (N Y). 2019 Aug 28;5(3):e87-e91. doi: 10.1055/s-0039-1694979. eCollection 2019 Jul. Surg J (N Y). 2019. PMID: 31475240 Free PMC article.
-
Comparison of two different concepts of mesh and fixation technique in laparoscopic ventral hernia repair: a randomized controlled trial.Surg Endosc. 2016 Mar;30(3):1188-97. doi: 10.1007/s00464-015-4329-0. Epub 2015 Jul 3. Surg Endosc. 2016. PMID: 26139491 Clinical Trial.
-
Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the first Italian Consensus Conference.Hernia. 2013 Oct;17(5):557-66. doi: 10.1007/s10029-013-1055-1. Epub 2013 Feb 12. Hernia. 2013. PMID: 23400528 Review.
References
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Miscellaneous