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A Meta-analysis

Philip P. Goodney, MD; Christian M. Birkmeyer, MS; John D. Birkmeyer, MD

Arch Surg. 2002;137:1161-1165.

Background  Although laparoscopic repair of ventral hernia has become increasingly popular, its outcomes relative to open repair have not been well characterized. For this reason, we performed a meta-analysis of studies comparing open and laparoscopic ventral (including incisional) hernia repair.

Hypothesis  Laparoscopic ventral hernia repair results in better short-term outcomes than open ventral hernia repair.

Data Sources  Structured MEDLINE search for published studies. One unpublished study was also identified.

Study Selection  Studies were selected on the basis of study design (comparison of laparoscopic and open ventral hernia repair). The 3 main outcome measures were perioperative complications, operative time, and length of hospital stay. Of 83 potential studies identified by abstract review, 8 (10%) met the inclusion criteria.

Data Extraction  Two reviewers assessed each article to determine eligibility for inclusion and, where appropriate, abstracted information on patient characteristics and main outcome measures.

Data Synthesis  Across 8 studies, 390 patients underwent open repair and 322 underwent laparoscopic repair. Perioperative complications were less than half as likely to occur in patients undergoing laparoscopic repair (14% vs 27%; P = .03; odds ratio, 0.42; 95% confidence interval, 0.29-0.68). Average length of stay was shorter in the laparoscopic group (2.0 vs 4.0 days; P = .02). No statistically significant difference in operative times was noted between laparoscopic and open repair (99 vs 96 minutes; P = .38).

Conclusions  Laparoscopic ventral hernia repair offers lower complication rates and shorter length of stay than open repair. However, randomized controlled trials and studies with long-term follow-up are needed to confirm these findings and to assess long-term rates of hernia recurrence.

From the VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt (Drs Goodney and J. D. Birkmeyer); the Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Goodney and J. D. Birkmeyer and Mr C. M. Birkmeyer); and the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Drs Goodney and J. D. Birkmeyer and Mr C. M. Birkmeyer).

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