Laparoscopic versus open mesh repair for the treatment of recurrent inguinal hernia: A systematic review and meta-analysis

Abstract

Background: Inguinal hernia repair is a common surgical procedure; however, the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia are unclear. This study aimed to evaluate the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia by conducting a meta-analysis of randomized controlled trials (RCTs). Methods: A comprehensive, meta-analysis of RCTs on the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia was performed. English- and Chinese-language studies published up to December 30, 2017 were identified via a systematic search of the PubMed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Summary odd ratios or weighted mean differences (MDs) with 95% confidence intervals (CIs) were adopted to calculate each outcome using a fixed or random effects model. Results: Ten RCTs involving a total of 1,017 patients were included. There was no statistically significant difference in the rate of recurrence (P=0.23; OR: 0.74, 95% CI: 0.45-1.21), hematoma (P=0.47; OR: 0.71, 95% CI: 0.28-1.79), urinary retention (P=0.94; OR: 0.97, 95% CI: 0.46-2.07) and acute pain (P=0.71; OR: 0.74, 95% CI: 0.14-3.76) between the laparoscopic and open mesh repair groups. The incision infection rate (P=0.02; OR: 0.28, 95% CI: 0.10-0.81) of the laparoscopic group was lower and the length of hospital stay (P<0.0001; MD: -3.65, 95% CI: -4.76 to -2.53) was significantly shorter than those of the open repair group. However, the laparoscopic group had a longer operative time (P=0.0002; MD: 20.30, 95% CI: 9.60-31.01). Conclusions: The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.