Incisional hernia incidence following laparoscopic versus open abdominal surgery: an updated systematic review and meta-analysis of randomized controlled trials
- 01.12.2025
- Review
Erschienen in:
- Verfasst von
- Victor Perim
- Raquel Nogueira
- João P. G. Kasakewitch
- Carlos A. Balthazar da Silveira
- Diana Q. Nguyen
- Diego Laurentino Lima
- Leandro Totti Cavazzola
- Flavio Malcher
- Erschienen in
- Hernia | Ausgabe 1/2025
Abstract
Purpose
Incisional hernias (IH) are a frequent complication following open surgery (OP). While laparoscopic (LAP) surgery is designed to enhance patient recovery through smaller incisions, contemporary quantitative evidence supporting its efficacy in reducing IH rates (IHR) is sparse. This study aims to provide an overview of IHR following OP and LAP abdominal operations.
Methods
We searched for randomized controlled trials (RCTs) studies in PubMed, Cochrane, and Embase from inception until May 2024 comparing OP approach to LAP and reported IH incidence as a postoperative complication. Exclusion criteria included studies involving patients aged ≤ 18 years, those lacking a control group, or those with a follow-up period of less than 12 months. Studies were stratified by procedure type and by fully laparoscopic (T-LAP) versus laparoscopic-assisted (LAP-A) approaches. Statistical analyses were performed using RStudio software. To address potential clinical and methodological heterogeneity across studies, we applied the restricted maximum-likelihood estimator and random-effects models for outcome analysis.
Results
8.754 studies were screened, and 72 studies were reviewed. From the initial screening, 28 studies involving 6,113 patients were included, of which 3,337 (54.6%) underwent LAP. Analysis revealed a significantly lower incidence of IH among patients who received LAP (RR 0.51; 95% CI 0.33–0.79). Subgroup analysis by surgery type indicated that bariatric (RR 0.20; 95% CI 0.068–0.578) and fundoplication procedures (RR 0.1; 95%CI 0.018–0.545) were associated with a substantial reduction in IHR. Moreover, totally-laparoscopic (T-LAP) procedures showed a significant reduction in IHR (RR 0.26;95%CI 0.14–0.5), while LAP-A procedures failed to show the same benefit.
Conclusion
LAP surgery is associated with reduced IHR in abdominal operations, with the benefit being particularly notable amongst LAP-A, bariatric, and fundoplication procedures. These findings underscore the advantages of LAP in specific surgical contexts, emphasizing its potential to minimize postoperative complications such as IH. Further research focusing on comparing IHR on open versus LAP approaches is warranted.
Study registration
A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024551280).
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- Titel
- Incisional hernia incidence following laparoscopic versus open abdominal surgery: an updated systematic review and meta-analysis of randomized controlled trials
- Verfasst von
-
Victor Perim
Raquel Nogueira
João P. G. Kasakewitch
Carlos A. Balthazar da Silveira
Diana Q. Nguyen
Diego Laurentino Lima
Leandro Totti Cavazzola
Flavio Malcher
- Publikationsdatum
- 01.12.2025
- Verlag
- Springer Paris
- Erschienen in
-
Hernia / Ausgabe 1/2025
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204 - DOI
- https://doi.org/10.1007/s10029-025-03347-2
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