title: Open versus laparoscopic incisional hernia repair: something different from a meta-analysis.
abstract: BACKGROUND
  Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare the available alloplastic materials and try to clarify the question of whether the laparoscopic procedure is superior to the conventional (open) technique based on the available randomized studies.
  
  
  METHODS
  All available meshes for intraperitoneal and extraperitoneal implantation were described regarding their handling and their pros and cons. A database search (PubMed, Medline, Ovid, and in the secondary literature) was carried out to retrieve all randomized studies comparing laparoscopic and open hernia repair. Data were reviewed by two independent scientists for surgical and statistical design.
  
  
  RESULTS
  The ideal mesh for a laparoscopic maintenance of abdominal wall hernias as well as the optimal fixation of the mesh has not been found yet. Recent available literature shows no evidence demonstrating the superiority of one of these meshes. The available studies found a lower infection rate, but higher occurrence of seroma for the laparoscopic procedure. The value of the different studies is reduced due to deficiency in study design and power. Guidelines for further studies are discussed to avoid surgical and statistical pitfalls.
  
  
  CONCLUSIONS
  Laparoscopic incisional hernia repair shows, in some (randomized) studies as well as a large number of retrospective analyses and in case control studies, superiority compared to conventional hernia repair. Long-term results with a high level of evidence are not available. Additional well-designed randomized trials including long-term observation of patients are required in order to clarify a number of interesting questions.
authors.affiliation: Department of Surgery, Martin Luther Hospital, Lutherstrasse 22, 24837 Schleswig, Germany. mkapischke@web.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Kapischke
authors.forename: Tim
authors.initials: T
authors.lastname: Schulz
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schipper
authors.forename: Jochen
authors.initials: J
authors.lastname: Tensfeldt
authors.forename: Amke
authors.initials: A
authors.lastname: Caliebe
mesh_terms: D001672:Biocompatible Materials; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D015201:Meta-Analysis as Topic; D013526:Surgical Mesh
chemical_list: D001672:Biocompatible Materials