Meta-analysis Of Randomized Controlled Trials Comparing Open And Laparoscopic Incisional Hernia Repair

Objective:To compare the efficacy and safety between the laparoscopic and open surgery of incisional or ventral hernia with meta-analysis.Through this thesis,we expect to provide high quality evidence to choose a reasonable abdominal incisional hernia repair surgery for clinical therapy.Methods:All RCTs about laparoscopic and open surgery of incisional hernia were searched from PubMed,Ovid,Embase,Cochrane Library,Web of science,Chinese Bio-medicine Database,China Journal Full-text Database,WanFang database,VIP database(all database from establishment to February 2017)to assess duration of surgery,intraoperative blood loss,intestinal injury rate,intestinal obstruction rate,postoperative bleeding rate,seroma rate,hematoma rate,infection rate,length of hospital stay,The recurrence rate of incisional hernia.The quality of the included studies was assessed according to the cochrane handbook for systematic reviews of interventions version 5.3.Results:A total of 605 studies was retrieved,seventeen RCTs(1419 patients)were included.Compared with open surgery,laparoscopic surgery of incisional hernia can reduce the intraoperative blood loss(MD=-68.44,95%CI:-125.75?-11.14,P=0.02),decrease the rate of seroma(RR=0.25,95%CI:0.15-0.40,P<0.00001)and infection rate(RR=0.26,95%CI:0.15?0.45,P<0.00001),shorten the length of hospital stay(RR=-2.24,95%CI:-2.77?-1.71,P<0.00001).But laparoscopic surgery can not shorten the duration of surgery(MD=-1.29,95%CI:-11.35?8.77,P=0.80),can not decrease intestinal obstruction(RR=1.02,95%CI:0.41?2.55,P=0.96),can not decrease postoperative bleeding(RR=1.88,95%CI:0.41?8.71 P=0.42),can not decrease hematoma rate(RR=0.92,95%CI:0.55?1.56,=P0.77),can not decrease the recurrence of incisional hernia(RR=1.20,95%CI:0.82?1.74,P=0.35)and increase the rate of intestinal injury(RR=3.95,95%CI:0.99?15.74,P=0.05).Conclusion:There was no significant difference in the incidence of postoperative intestinal obstruction rate,postoperative bleeding rate,postoperative hematoma incidence rate and incisional hernia recurrence rate in laparoscopic incisional hernia repair and open surgery.Laparoscopic incisional hernia repair after the incidence of serum and the incidence of postoperative infection is lower than open surgery,and laparoscopic incisional hernia repair can reduce intraoperative blood loss,laparoscopic incisional hernia repair can shorten the length of stay,laparoscopic incisional hernia repair can reflecting the advantages of minimally invasive technology.However,the incidence of intestinal injury in laparoscopic repair surgery is more higher than that of open surgery,indicating that the postoperative incisional hernia repair surgery is more serious than the open group.In view of the overall quality of the RCTs included in the study.In order to provide more accurate evidence,a larger sample size,higher quality RCT study should be designed and carried out.