Julia B Kössler-Ebs1,2, Kathrin Grummich2, Katrin Jensen3, Felix J Hüttner1,2, Beat Müller-Stich1, Christoph M Seiler4, Phillip Knebel1,2, Markus W Büchler1, Markus K Diener5,6. 1. Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 2. Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. 3. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. 4. Josephs-Hospital Warendorf, General-, Visceral- and Vascular Surgery, Am Krankenhaus 2, 48231, Warendorf, Germany. 5. Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. markus.buechler@med.uni-heidelberg.de. 6. Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. markus.buechler@med.uni-heidelberg.de.
Abstract
BACKGROUND: Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence. METHODS: A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI). RESULTS: 24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD -0.06, 95 % CI [-0.09, -0.03], p = 0.0002, I (2) = 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD -0.14, 95 % CI [-0.22, -0.06], p = 0.001, I (2) = 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD -0.01, 95 % CI [-0.03, 0.01], p = 0.31, I (2) = 35 %). Wound infections were significantly reduced in the laparoscopic group (RD -0.06, 95 % CI [-0.09, -0.03], p < 0.0001, I (2) = 35 %); overall postoperative morbidity was comparable in both groups (RD -0.06, 95 % CI [-0.13, 0.00], p = 0.06; I (2) = 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD -1.92, 95 % CI [-2.67, -1.17], p < 0.00001, I (2) = 87 %). At short-term follow-up, quality of life was in favor of laparoscopy. CONCLUSIONS: Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.
BACKGROUND: Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence. METHODS: A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI). RESULTS: 24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD -0.06, 95 % CI [-0.09, -0.03], p = 0.0002, I (2) = 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD -0.14, 95 % CI [-0.22, -0.06], p = 0.001, I (2) = 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD -0.01, 95 % CI [-0.03, 0.01], p = 0.31, I (2) = 35 %). Wound infections were significantly reduced in the laparoscopic group (RD -0.06, 95 % CI [-0.09, -0.03], p < 0.0001, I (2) = 35 %); overall postoperative morbidity was comparable in both groups (RD -0.06, 95 % CI [-0.13, 0.00], p = 0.06; I (2) = 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD -1.92, 95 % CI [-2.67, -1.17], p < 0.00001, I (2) = 87 %). At short-term follow-up, quality of life was in favor of laparoscopy. CONCLUSIONS: Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.
Authors: Marco Braga; Nicolò Pecorelli; Matteo Frasson; Andrea Vignali; Walter Zuliani; Valerio Di Carlo Journal: World J Gastrointest Oncol Date: 2011-03-15
Authors: S A L Bartels; M S Vlug; M W Hollmann; M G W Dijkgraaf; D T Ubbink; H A Cense; B A van Wagensveld; A F Engel; M F Gerhards; W A Bemelman Journal: Br J Surg Date: 2014-06-30 Impact factor: 6.939
Authors: Patrick Heger; Pascal Probst; Felix J Hüttner; Käthe Gooßen; Tanja Proctor; Beat P Müller-Stich; Oliver Strobel; Markus W Büchler; Markus K Diener Journal: World J Surg Date: 2017-11 Impact factor: 3.352
Authors: Käthe Goossen; Solveig Tenckhoff; Pascal Probst; Kathrin Grummich; André L Mihaljevic; Markus W Büchler; Markus K Diener Journal: Langenbecks Arch Surg Date: 2017-12-05 Impact factor: 3.445
Authors: Francisco Asencio; Juan Carbó; Ramón Ferri; Salvador Peiró; Javier Aguiló; Inmaculada Torrijo; Sebastian Barber; Raul Canovas; Juan Carlos Andreu-Ballester Journal: World J Surg Date: 2021-05-20 Impact factor: 3.352
Authors: J van Hilst; E A Strating; T de Rooij; F Daams; S Festen; B Groot Koerkamp; J M Klaase; M Luyer; M G Dijkgraaf; M G Besselink Journal: Br J Surg Date: 2019-04-23 Impact factor: 6.939