Laparoscopic Compared With Open Methods Of Groin Hernia Repair In Adult: Systematic Review Of Clinical Controlled Trials

Objective:To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adult.Methods:A fully recursive literature search was conducted in PubMed (1990to September,2009), EMBASE (1990to September,2009), Cochrane Central Register of Controlled Trials (Issue3,2009), CBM (1990to September,2009), CNKI and VIP Chinese Scientific Journals Full-text Database1990to September,2009) in any language. Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adult were considered for inclusion. The four outcomes variables analysed were chronic pain, long term recurrence, intraoperative complications and postoperative complication. Data related clinical outcome was extracted by two reviewers independently. Statistical analyses were carried out using RevMan5.0software.Results:Eighteen published reports of eligible studies involving5816participants met the inclusion criteria. Compared with open methods, laparoscopic inguinal hernia had no significant difference in long term recurrence rate [OR1.53,95%CI (1.00to2.34), P=0.05] and postoperative complication rate [OR0.74,95%CI (0.52to1.05), P=0.09], and had lower tendency chronic pain [OR0.45,95%CI (0.34to0.59), P<0.00001] with statistical significance. There was a statistical difference in intraoperative complications between two groups [OR2.15,95%CI (1.32to3.53), P=0.002].Conclusion:Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain.There is no significant in long term recurrence rate and postoperative complication between two methods. More studies are needed for intraoperative complications and other long term postoperative complications.