Document Detail


A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia.
MedLine Citation:
PMID:  22470068     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Laparoscopic inguinal hernia repair (LIHR), using a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) technique, is an alternative to conventional open inguinal hernia repair (OIHR). A consensus on outcomes of LIHR when compared with OIHR for primary, unilateral, inguinal hernia has not been reached.
OBJECTIVES: Perform a meta-analysis of all randomized controlled trials (RCTs) comparing OIHR and LIHR for primary unilateral inguinal hernia. Outcomes were hernia recurrence and surgery-related morbidity.
METHODS: A comprehensive search for published RCTs comparing LIHR with OIHR for primary, unilateral, and inguinal hernia was performed. Reviews of each study were conducted and data were extracted. Random effect methods were used to combine data.
RESULTS: Data were retrieved from 27 RCTs describing 7161 patients. An increased risk in hernia recurrence existed when LIHR was compared with OIHR (relative risk [RR] = 2.06, 95% confidence interval [CI] = 1.26-3.37, P = 0.004). TAPP had equivalent recurrence (RR = 1.14, 95% CI = 0.78-1.68, P = 0.491) but TEP had increased recurrence of risk (RR = 3.72, 95% CI = 1.66-8.35, P = 0.001) relative to OIHR. LIHR was associated with greater perioperative complication risk than OIHR (RR = 1.22, 95% CI = 1.04-1.42, P = 0.015). TAPP (RR = 1.47, 95% CI = 1.18-1.84, P < 0.001) but not TEP (RR = 1.05, 95% CI = 0.85-1.30, P = 0.667) was associated with this increased complication risk. LIHR was associated with reduced risk of chronic pain (RR = 0.66, 95% CI = 0.51-0.87, P = 0.003) and chronic numbness (RR = 0.27, 95% CI = 0.12-0.58, P < 0.001) relative to OIHR.
CONCLUSIONS: For primary unilateral inguinal hernia, TEP is associated with an increased risk of recurrence relative to OIHR but TAPP is not. TAPP is associated with increased risk of perioperative complications relative to OIHR. LIHR has a reduced risk of chronic pain and numbness relative to OIHR.
Authors:
Elma A O'Reilly; John P Burke; P Ronan O'Connell
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis    
Journal Detail:
Title:  Annals of surgery     Volume:  255     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-16     Completed Date:  2012-06-12     Revised Date:  2012-09-11    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  846-53     Citation Subset:  AIM; IM    
Affiliation:
Surgical Professorial Unit, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
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MeSH Terms
Descriptor/Qualifier:
Groin
Hernia, Inguinal / surgery*
Humans
Hypesthesia / epidemiology
Laparoscopy / methods*
Pain, Postoperative / epidemiology
Perioperative Period
Randomized Controlled Trials as Topic
Recurrence
Comments/Corrections
Erratum In:
Ann Surg. 2012 Aug;256(2):393

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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