Incisional hernias are a common complication following abdominal surgery, and represent about 80% of all ventral hernia.
In uncomplicated postoperative follow-up, incisional hernias develop in about 11% of cases and in up to 23% of cases with wound infections or other forms of wound complications.
|There was a trend towards lower recurrence rates with laparoscopic surgery|
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.
Dr Falk Müller-Riemenschneider and colleagues from Germany
compared the medical effectiveness and safety of conventional mesh and laparoscopic incisional hernia repair.
The research team conducted a structured literature search of databases accessed through the German Institute of Medical Documentation and Information.
The team searched English and German literature published until 2005, and assessed their methodological quality.
The researchers identified 17 relevant publications, and included 15 studies for final assessment.
The research team identified 1 meta-analysis, 1 randomized clinical trial, and 13 cohort studies.
All studies suffered from significant methodological limitations.
Methodological limitations included differences in baseline characteristics between treatment groups, small case numbers, and the lack of adjustment for relevant confounders.
Overall, the researchers found that 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 with laparoscopic repair.
The team observed 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 patient-related factors was not assessed in any of the studies.
Dr Müller-Riemenschneider's team concluded, "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."