Preliminary results of meta-analysis of laparoscopic and open inguinal hernia repair

Abstract

Purpose: The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic inguinal herniorrhaphy (LIHR) and open inguinal herniorrhaphy (OIHR). Data Sources and Review Methods: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials (RCTs) that compared LIHR and OIHR published in the English literature between January 1990 and January 2007. The six outcome variables analysed were operating time, hospital stay, return to normal activity, return to work, total complications and recurrence rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences. Results: Fifty-nine trials were considered suitable for the meta-analysis. A total of 8092 patients underwent LIHR and 8580 had OIHR. For three of the six outcomes the summary point estimates favoured LIHR over OIHR; there was a significant reduction of 34% in the relative odds of postoperative complications, 4.99 days in time to return to normal activity and 6.39 days in time to return to work. However, there was a significant increase of 14.08 min in the mean operating time for LIHR. The relative odds of short term recurrence increased by 20 percent for LIHR compared with OIHR. There was a small trend towards decreased duration of hospital stay for LIHR compared with OIHR, although these results were not statistically significant. Conclusions: Based on this meta-analysis, LIHR offers patients a number of benefits over OIHR at the expense of longer operating time but comparable recurrence rate and hospital stay.