Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia.
BACKGROUND
Although there is plentiful evidence regarding the use of laparoscopic surgery for primary inguinal hernia, there is a paucity of literature concerning its role after recurrence. There has been no quantitative review of the evidence, despite suggestions that pooled analysis of existing data is required.


METHODS
Medline, Embase, trial registries, conference proceedings and reference lists were searched for controlled trials of laparoscopic versus conventional open surgery for mesh repair of recurrent hernia. The primary outcomes were recurrence and chronic pain. Secondary outcomes were operating time, visual analogue pain score, superficial wound infection, haematoma or seroma formation, time to return to normal activities and serious complications requiring operation. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes.


RESULTS
Four trials were included in the analysis. There was no effect on recurrence or chronic pain. Laparoscopic surgery was associated with significantly less postoperative pain, a quicker return to normal activities and fewer wound infections, at the cost of a longer operating time. There was no difference in haematoma formation or the need for additional operations.


CONCLUSIONS
Careful patient selection and surgeons' experience are important in the selection of technique for recurrent inguinal hernia repair.
Karthikesalingam
A
A
Department of Outcomes Research, St George's Vascular Institute, London, UK. alankarthi@googlemail.com
Markar
S R
SR
Holt
P J E
PJ
Praseedom
R K
RK
D006406:Hematoma / Q000209:etiology; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome