Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 23; no. 3; pp. 461 - 472
• Main Authors: Bullen, N. L., Massey, L. H., Antoniou, S. A., Smart, N. J., Fortelny, R. H.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.06.2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Chronic pain; Clinical trials; Forum on primary monolateral uncomplicated inguinal hernia; Hernia; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - methods; Humans; Laparoscopy; Male; Medicine; Medicine & Public Health; Meta-analysis; Morbidity; Pain; Quality of life; Review; Statistical analysis; Surgical Mesh; Systematic review; Treatment Outcome; TAPP; Lichtenstein; Inguinal hernia; TEP
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-019-01989-7

Background One standard repair technique for groin hernias does not exist. The objective of this study is to perform an update meta-analysis and trial sequential analysis to investigate if there is a difference in terms of recurrence between laparoscopic and open primary unilateral uncomplicated inguinal hernia repair. Methods The reporting methodology conforms to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Randomised controlled trials only were included. The intervention was laparoscopic mesh repair (transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)). The control group was Lichtenstein repair. The primary outcome was recurrence rate and secondary outcomes were acute and chronic post-operative pain, morbidity and quality of life. Results This study included 12 randomised controlled trials with 3966 patients randomised to Lichtenstein repair ( n  = 1926) or laparoscopic repair ( n  = 2040). There were no significant differences in recurrence rates between the laparoscopic and open groups (odds ratio (OR) 1.14, 95% CI 0.51–2.55, p  = 0.76). Laparoscopic repair was associated with reduced rate of acute pain compared to open repair (mean difference 1.19, CI − 1.86, − 0.51, p  ≤ 0.0006) and reduced odds of chronic pain compared to open (OR 0.41, CI 0.30–0.56, p  ≤ 0.00001). The included trials were, however, of variable methodological quality. Trial sequential analysis reported that further studies are unlikely to demonstrate a statistically significant difference between the two techniques. Conclusion This meta-analysis and trial sequential analysis report no difference in recurrence rates between laparoscopic and open primary unilateral inguinal hernia repairs. Rates of acute and chronic pain are significantly less in the laparoscopic group.