Comparative analysis of laparoscopic, retro-muscular, and open mesh repair techniques for ventral and incisional hernias: a comprehensive review and meta-analysis.

Abstract

Ventral hernias are abnormalities in anterior abdominal wall occurring due to an incision or are congenital. This comprehensive review and meta-analysis aim to objectively compare laparoscopic to retro-muscular or any other mesh repair approach to manage ventral incisional hernia. To identify studies that managed ventral incisional hernia using laparoscopic, open, or retro-muscular mesh repair techniques, a comprehensive literature search was performed. Random effects model was used, and data were presented as log odds ratio (logOR) or as Hedge's g with corresponding 95% confidence intervals (CI). Cochran's Q test was implemented to measure heterogeneity among articles, and funnel plots were utilized to examine publication bias visually. Quality of all selected studies was assessed using Critical Appraisal Checklists for Studies developed by the Joanna Briggs Institute. 20 studies (16,247 patients) were included published from 2003 to 2023. Significantly reduced incisional hernias developed in laparoscopic group. The recurrence of hernia lowered with laparoscopic repair vs. open repair. In retro-muscular vs. laparoscopic, recurrence was lower, however, not statistically significant (p = 0.97). Open repair type resulted in a longer hospital stay than laparoscopic (p = 0.03). In laparoscopic repair, the postoperative complications reduced compared to the open repair (p = 0.02). Laparoscopic incisional and ventral hernia repair is a practical and successful alternative to open method. It is associated with shorter hospital stay and lower risk of postoperative complications. In few instances, retro-muscular mesh repair may be opted for.