Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia

Abstract

The repair of recurrent inguinal hernia is a more complex undertaking, accounting for up to 15 per cent of all hernia surgeries whether by open tension free or laparoscopic surgery. Advantages of laparoscopic procedures may include a reduction in postoperative pain and hospital stay, and the ability to undertake a simultaneous repair of symptomatic incipient contralateral herniation. However, open repair can be performed under local anesthesia and is preferred by many surgeons. However, there is still much controversy about the ideal technique for recurrent hernia repair. Objective: To compare between the two approaches Open tension free and laparoscopic repair of recurrent inguinal hernia after a previous mesh repair, in terms of operative time, infection, postoperative pain scores, recurrence and chronic pain. Methods: This study is metanalysis of prospective randomized controlled studies that was published at the period between 2008 and 2018, between open tension free and Laparoscopic (mainly TAPP) repair of recurrent inguinal hernia after a previous mesh repair. For this systematic review, PubMed/Medline and ScienceDirect online databases were searched using the keywords operative time, infection, postoperative pain scores, recurrence and chronic pain. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable. Results: The results of the current meta-analysis showed that significantly fewer patients with Post-operative pain scores were found in the laparoscopic group. The main disadvantage of laparoscopic repair has been the duration of the operation as the mean operative time was longer in the laparoscopic operations, but without significant statistical difference. The Metanalysis of re-recurrence rate was lower in the laparoscopic than in the open group, with statistically significant difference, while the meta-analysis of chronic pain showed non-significant difference between the two approaches. Wound infection was discussed in two studies, with no statistically significant difference. Conclusion: The main advantage of the laparoscopic approach is decreasing the risk of recurrence and post-operative pain scores. No significant difference of outcome regarding chronic pain, surgical site infection or operative time.