Laparoscopic Compared With Open Ten-free Methods Of Recurrent Inguinal Hernia Repair In Adults: A Meta Analysis

Objective: To evaluate the efficacy and safety of laparoscopic and open Ten-Free hernia repair in adult recurrent inguinal hernia by Meta analysis.Methods: Literature retrieval was fully conducted from the following eight common databases( PubMed, EMbase, Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database) in English and Chinese by the computer and supplemented by other retrieval methods at the same time, the retrieval time ranged from January 1990 to May 2014. We collected all the randomized controlled trials(RCT) about the comparison of the two different surgical methods of the efficacy and safety in adult recurrent inguinal hernia. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and cross-checked. Statistical analyses were carried out by RevMan 5.3 software.Results: A total of eleven randomized controlled trials involving 1039 patients were included in the study. The results of Meta-analysis showed that the difference between the incidence of chronic pain [OR= 0.40, 95%CI(0.20, 0.82), P= 0.01], postoperative incision infection rate [OR= 0.28, 95%CI(0.10, 0.81), P= 0.02], postoperative recovery of daily activity time [Foreign: MD=-4.54, 95%CI(-5.59,-3.49), P< 0.00001; Domestic: MD=-2.24, 95%CI(-2.55,-1.93), P< 0.00001] and the operative time [MD= 4.57, 95%CI(2.83, 6.30), P< 0.00001] had statistical significance of the two different surgical methods to the recurrent inguinal hernia. But the two different surgical methods had no statistical significant difference between the postoperative recurrence rate [OR= 0.75, 95%CI(0.46, 1.21), P= 0.24], acute pain [OR= 0.74, 95%CI(0.14, 3.76), P= 0.71], hematoma/seroma [OR= 0.73, 95%CI(0.48, 1.11), P= 0.14] and the incidence of urinary retention [OR= 0.97, 95%CI(0.46, 2.07), P= 0.94].Conclusion: Compared with open tension-free surgery, laparoscopic surgery can not only reduce the incidence of chronic pain and postoperative incision infection rate but also shorten the postoperative recovery of daily activity time of the recurrent inguinal hernia, but the operative time of the laparoscopic surgery was longer. According to the patients’ specific circumstances and requirements, combined with the experience of the clinicians to choose the best surgical method in order to obtain a good surgical effect.