S Hajibandeh3,4, S Hajibandeh3,4, A Sreh4, A Khan4, D Subar4, L Jones4. 1. Department of General Surgery, Salford Royal Hospital, Salford, UK. shahab_hajibandeh@yahoo.com. 2. Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK. shahab_hajibandeh@yahoo.com. 3. Department of General Surgery, North Manchester General Hospital, Manchester, UK. 4. Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK.
Abstract
OBJECTIVES: To compare outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. METHODS: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (Registration Number: CRD42016052131). We conducted a search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists to identify all randomised controlled trials (RCTs) and observational studies comparing outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. We used the Cochrane risk of bias tool and the Newcastle-Ottawa scale to assess the risk of bias of RCTs and observational studies, respectively. Random effects models were applied to calculate pooled outcome data. RESULTS: We identified three RCTs and seven retrospective cohort studies, enrolling a total of 16,549 patients. Our analyses indicated that open repair was associated with a higher risk of wound infection [Odds ratio (OR) 2.35, 95% CI 1.23-4.48, P = 0.010], wound dehiscence (OR 4.99, 95% CI 1.12-22.28, P = 0.04) and recurrence (OR 4.06, 95% CI 1.54-10.71, P = 0.005), longer length of hospital stay (MD 26.85, 95% CI 8.15-45.55, P = 0.005) and shorter operative time [Mean difference (MD) - 23.07, 95% CI - 36.78 to - 9.35, P = 0.0010] compared to laparoscopic repair. There was no difference in the risk of haematoma (OR 2.03, 95% CI 0.22-18.73, P = 0.53) or seroma (OR 0.67, 95% CI 0.19-2.32, P = 0.53) between the two groups. CONCLUSIONS: The best available evidence (randomised and non-randomised studies) suggests that laparoscopic repair of umbilical or paraumbilical hernias may be associated with a lower risk of wound infection, wound dehiscence and recurrence rate, shorter length of stay but longer operative time. Results from a limited number of RCTs showed no difference in recurrence rates. The quality of the best available evidence is moderate, and selection bias is the major concern due to non-randomised design in most of the available studies. Therefore, considering the level of available evidence, the most reliable approach for repair of umbilical or paraumbilical hernia should be based on surgeon's experience, clinical setting, patient's age and size, hernia defect size and anatomical characteristics. High quality RCTs are required.
OBJECTIVES: To compare outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. METHODS: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (Registration Number: CRD42016052131). We conducted a search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists to identify all randomised controlled trials (RCTs) and observational studies comparing outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. We used the Cochrane risk of bias tool and the Newcastle-Ottawa scale to assess the risk of bias of RCTs and observational studies, respectively. Random effects models were applied to calculate pooled outcome data. RESULTS: We identified three RCTs and seven retrospective cohort studies, enrolling a total of 16,549 patients. Our analyses indicated that open repair was associated with a higher risk of wound infection [Odds ratio (OR) 2.35, 95% CI 1.23-4.48, P = 0.010], wound dehiscence (OR 4.99, 95% CI 1.12-22.28, P = 0.04) and recurrence (OR 4.06, 95% CI 1.54-10.71, P = 0.005), longer length of hospital stay (MD 26.85, 95% CI 8.15-45.55, P = 0.005) and shorter operative time [Mean difference (MD) - 23.07, 95% CI - 36.78 to - 9.35, P = 0.0010] compared to laparoscopic repair. There was no difference in the risk of haematoma (OR 2.03, 95% CI 0.22-18.73, P = 0.53) or seroma (OR 0.67, 95% CI 0.19-2.32, P = 0.53) between the two groups. CONCLUSIONS: The best available evidence (randomised and non-randomised studies) suggests that laparoscopic repair of umbilical or paraumbilical hernias may be associated with a lower risk of wound infection, wound dehiscence and recurrence rate, shorter length of stay but longer operative time. Results from a limited number of RCTs showed no difference in recurrence rates. The quality of the best available evidence is moderate, and selection bias is the major concern due to non-randomised design in most of the available studies. Therefore, considering the level of available evidence, the most reliable approach for repair of umbilical or paraumbilical hernia should be based on surgeon's experience, clinical setting, patient's age and size, hernia defect size and anatomical characteristics. High quality RCTs are required.
Authors: Juan M Perrone; Nathaniel J Soper; J Christopher Eagon; Mary E Klingensmith; Rebecca L Aft; Margaret M Frisella; L Michael Brunt Journal: Surgery Date: 2005-10 Impact factor: 3.982
Authors: Alessandro Liberati; Douglas G Altman; Jennifer Tetzlaff; Cynthia Mulrow; Peter C Gøtzsche; John P A Ioannidis; Mike Clarke; P J Devereaux; Jos Kleijnen; David Moher Journal: BMJ Date: 2009-07-21
Authors: J M McGreevy; P P Goodney; C M Birkmeyer; S R G Finlayson; W S Laycock; J D Birkmeyer Journal: Surg Endosc Date: 2003-09-10 Impact factor: 4.584
Authors: S Kapoulas; A Papalois; G Papadakis; G Tsoulfas; E Christoforidis; B Papaziogas; D Schizas; G Chatzimavroudis Journal: Hernia Date: 2021-01-05 Impact factor: 4.739
Authors: A Fafaj; L Tastaldi; H Alkhatib; S Tish; R AlMarzooqi; M A Olson; T G Stewart; C Petro; D Krpata; M Rosen; A Prabhu Journal: Hernia Date: 2020-05-23 Impact factor: 4.739
Authors: Jonathan Douissard; Jeremy Meyer; Arnaud Dupuis; Andrea Peloso; Julie Mareschal; Christian Toso; Monika Hagen Journal: Int J Surg Protoc Date: 2020-04-04