TY - JOUR

T1 - Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair

T2 - A systematic review

AU - Müller-Riemenschneider, Falk

AU - Roll, Stephanie

AU - Friedrich, Meik

AU - Zieren, Juergen

AU - Reinhold, Thomas

AU - Von Der Schulenburg, J. Matthias Graf

AU - Greiner, Wolfgang

AU - Willich, Stefan N.

PY - 2007/12

Y1 - 2007/12

N2 - Background: Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of laparoscopic surgery is increasing. It therefore remains uncertain which technique should be recommended as the standard of care. Objectives: To compare the medical effectiveness and safety of conventional mesh and laparoscopic incisional hernia repair. Methods: A structured literature search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI) was conducted. English and German literature published until August 2005 was included and their methodological quality assessed. Results: The search identified 17 relevant publications and included 15 studies for final assessment. Among those were one meta-analysis, one randomized clinical trial (RCT) ,and 13 cohort studies. All studies suffered from significant methodological limitations, such as differences in baseline characteristics between treatment groups, small case numbers, and the lack of adjustment for relevant confounders. Overall, medical effectiveness and safety were similar for both surgical approaches. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative pain as well as decreased complication rates for the laparoscopic repair in the majority of studies. The impact of the technique of mesh implantation and mesh fixation as well as the impact of certain patien- related factors was not systematically assessed in any of the studies. Conclusion: No conclusive differences could be identified between the operative techniques. There was, however, some evidence for a trend towards similar or slightly improved outcomes associated with the laparoscopic procedure. There remains an urgent need for high-quality prospective studies to evaluate this question conclusively.

AB - Background: Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of laparoscopic surgery is increasing. It therefore remains uncertain which technique should be recommended as the standard of care. Objectives: To compare the medical effectiveness and safety of conventional mesh and laparoscopic incisional hernia repair. Methods: A structured literature search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI) was conducted. English and German literature published until August 2005 was included and their methodological quality assessed. Results: The search identified 17 relevant publications and included 15 studies for final assessment. Among those were one meta-analysis, one randomized clinical trial (RCT) ,and 13 cohort studies. All studies suffered from significant methodological limitations, such as differences in baseline characteristics between treatment groups, small case numbers, and the lack of adjustment for relevant confounders. Overall, medical effectiveness and safety were similar for both surgical approaches. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative pain as well as decreased complication rates for the laparoscopic repair in the majority of studies. The impact of the technique of mesh implantation and mesh fixation as well as the impact of certain patien- related factors was not systematically assessed in any of the studies. Conclusion: No conclusive differences could be identified between the operative techniques. There was, however, some evidence for a trend towards similar or slightly improved outcomes associated with the laparoscopic procedure. There remains an urgent need for high-quality prospective studies to evaluate this question conclusively.

KW - Abdominal

KW - Endoscopy

KW - Hernia

KW - Incisional

UR - http://www.scopus.com/inward/record.url?scp=36249002921&partnerID=8YFLogxK

U2 - 10.1007/s00464-007-9513-4

DO - 10.1007/s00464-007-9513-4

M3 - Article

C2 - 17763905

AN - SCOPUS:36249002921

VL - 21

SP - 2127

EP - 2136

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 12

ER -