Minimally invasive approach in emergency for the treatment of acute incarcerated/strangulated ventral hernias. A systematic review and meta-analysis

Abstract

Background: This study aims to report the currently available evidence on minimally invasive surgery (MIS) in emergency settings for treating acute incarcerated/strangulated ventral, primary, or incisional hernias and compare it with the open approach.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.

Results: Six articles were included. Results of the meta-analysis based on 1720 patients and two articles show that the mean operative time was shorter in the open repair group compared to the MIS group (mean difference [MD], 39.53 min; p < 0.0002). Overall, 116 (13.6%) and 181 (20.9%) postoperative complications were observed after MIS and open repair, respectively (relative risk [RR], 0.65; p = 0.61). MIS was associated with a statistically significantly lower wound complication rate than the open approach (RR, 0.43; p = 0.50). The two approaches showed equivalent results regarding return to the operative room (RR, 0.61; p = 0.13). The mean hospital stay in the MIS group was shorter than the open group (MD, -0.68; p = 0.99).

Conclusions: MIS in emergency settings seems feasible for treating acute incarcerated ventral hernias. However, due to the limitations of the included studies, the obtained evidence should be analyzed with caution. Further prospective studies are required to draw definitive conclusions.

Keywords: Ventral hernia; acute incarcerated/strangulated hernia; incisional hernia; laparoscopic ventral hernia repair; robotic ventral hernia repair.