Efficacy And Safety Between Laparoscopic And Open Surgery Of Incisional Hernia

Objective：To compare the efficacy and safety between laparoscopic and opensurgery of incisional hernia.Methods：All RCTs about laparoscopic and open surgery of incisional hernia weresearched from Wanfang database, VIP database, China Journal Full-text Database,Chinese Bio-medicine Database, PubMed, EMBASE, Cochrane Library and Web ofscience(from establishment to November2013), to assess Duration of surgery,intraoperative blood loss, Intestinal injury rate,Intestinal obstruction rate,Postoperative bleeding rate, seroma rate, hematoma rate, Infection rate, Skin necrosisrate, Length of hospital stay, The recurrence rate of incisional hernia. The quality ofthe included studies was assess according to the Cochrane Handbook for SystematicReviews of Interventions Version5.2.Results：Thirteen RCTs(1220patients) were included. Compared with open surgery,laparoscopic surgery of incisional hernia can reduce intraoperative blood loss(MD=-65.19,95%CI:-121.96~-8.42, P=0.02), decrease the rate of seroma (RR=0.18,95%CI:0.10~0.33, P<0.0001) and Infection (RR=0.24,95%CI:0.13~0.42,P<0.00001), shorten the Length of hospital stay (RR=-1.73,95%CI:-2.24~-1.23,P<0.00001). But laparoscopic surgery of incisional hernia can not shorten theduration of surgery (MD=-4.10,95%CI:-18.53~10.32, P=0.58), can not decreaseIntestinal obstruction (RR=1.02,95%CI:0.41~2.55, P=0.96), Postoperative bleeding(RR=1.88,95%CI:0.41~8.71, P=0.42), hematoma (RR=0.92,95%CI:0.55~1.56,P=0.77), Skin necrosis (RR=0.66,95%CI:0.26~1.66, P=0.37), recurrence (RR=1.20,95%CI:0.82~1.75, P=0.35) and increase the rate of Intestinal injury (RR=3.95,95%CI:0.99~15.74, P=0.05).Conclusions：The current evidence shows that laparoscopic surgery can reduceintraoperative blood loss, decrease the rate of seroma and Infection, shorten theLength of hospital stay, But can not decrease the rate of Intestinal obstruction, Postoperative bleeding, hematoma, Skin necrosis recurrence and increase the rate ofIntestinal injury.