title: Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery-A Systematic Review and Meta-Analysis.
abstract: Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence.
  
  
  
  A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI).
  
  
  
  24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD -0.06, 95 % CI [-0.09, -0.03], p = 0.0002, I (2) = 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD -0.14, 95 % CI [-0.22, -0.06], p = 0.001, I (2) = 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD -0.01, 95 % CI [-0.03, 0.01], p = 0.31, I (2) = 35 %). Wound infections were significantly reduced in the laparoscopic group (RD -0.06, 95 % CI [-0.09, -0.03], p < 0.0001, I (2) = 35 %); overall postoperative morbidity was comparable in both groups (RD -0.06, 95 % CI [-0.13, 0.00], p = 0.06; I (2) = 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD -1.92, 95 % CI [-2.67, -1.17], p < 0.00001, I (2) = 87 %). At short-term follow-up, quality of life was in favor of laparoscopy.
  
  
  
  Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Julia B
authors.initials: JB
authors.lastname: Kössler-Ebs
authors.affiliation: Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Grummich
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Jensen
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Hüttner
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Beat
authors.initials: B
authors.lastname: Müller-Stich
authors.affiliation: Josephs-Hospital Warendorf, General-, Visceral- and Vascular Surgery, Am Krankenhaus 2, 48231, Warendorf, Germany.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Seiler
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Phillip
authors.initials: P
authors.lastname: Knebel
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. markus.buechler@med.uni-heidelberg.de.|Study Center of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. markus.buechler@med.uni-heidelberg.de.
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
mesh_terms: D000005:Abdomen / Q000601:surgery*; D006801:Humans; D000069290:Incisional Hernia / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life