Meta-analysis of laparoscopic inguinal hernia trials favors open hernia repair with preperitoneal mesh prosthesis.
BACKGROUND
This meta-analysis was performed to determine the degree to which improvements in open hernia repair (OHR) in the last decade have altered the relative benefit of laparoscopic hernia repair (LHR).


METHODS
Twenty-seven comparative trials including 4,688 randomized patients were evaluated.


RESULTS
Within the control OHR, patients with routine mesh repair returned to work earlier than a sutured repair (16.4 versus 27.3 days, P = 0.010). During the study period, the increased use of mesh in OHR (3 of 12 initially versus 9 of 15 subsequent studies) was associated with an earlier return to work (25.9 to 16.8 days, P = 0.017); there was no significant improvement with corresponding LHR.


CONCLUSIONS
Although LHR was associated with an earlier return to work compared with conventional sutured OHR, more recent mesh OHRs provide equivalent outcomes but at lower costs and potentially less severe complications, supporting an open technique using preperitoneal mesh prostheses as the optimal hernia repair.
Department of Surgery, University of Mississippi School of Medicine, Jackson, MS, USA. crvoyles@yahoo.com
C Randle
CR
Voyles
Brian J
BJ
Hamilton
William D
WD
Johnson
Nobuyasu
N
Kano
D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D016032:Randomized Controlled Trials as Topic; D013526:Surgical Mesh; D016896:Treatment Outcome