Laparoscopic Versus Open Approach for Emergency Repair of Groin Hernias: A Systematic Review and Meta-Analysis.

Abstract

Background: Although open repair has historically been the preferred approach over laparoscopic repair for acutely strangulated and incarcerated groin hernias, the laparoscopic approach is gaining popularity. This systematic review and meta-analysis aims to investigate the safety and clinical outcomes of laparoscopic and open groin hernia repair in the emergency setting.

Methods: PubMed, Embase, Scopus, Cochrane Library, and Web of Science were systematically searched for articles comparing clinical outcomes between laparoscopic and open emergency groin hernia repair in adult patients. The primary outcome was the length of hospital stay. Secondary outcomes included operative time, postoperative complications, recurrence, reoperation, postoperative mortality, and the rate of conversion from laparoscopic to open repair. Risk of bias was assessed.

Results: Thirteen articles (4 prospective and 9 retrospective cohort studies) were included, with a total of 38,659 patients enrolled. Laparoscopic repair resulted in shorter length of hospital stay (MD -2.96 days [95% CI -4.91, -1.01] and p = 0.0074) and lower risk of wound infection (RR 0.29 [95% CI 0.20, 0.43] and p < 0.0001]. No statistically significant differences were observed between the two groups regarding operative time (p = 0.1006), risk of seroma formation (p = 0.3142), and risk of respiratory complication (p = 0.9880). Rate of conversion from laparoscopic to open repair as recorded in five studies was 2.78% ([95% CI 0.60, 11.92]).

Conclusion: Emergency laparoscopic repair of groin hernias results in shorter length of hospital stay and lower risks of postoperative morbidity and mortality, with no difference in operative time when compared to open repair. Although further large-scale prospective cohort studies and randomized controlled trials may be required to draw definitive conclusionsregarding the optimal surgical approach, laparoscopic repair of groin hernias appears to be a safe and feasible alternative to conventional open repair in the acute setting.