Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair

Abstract

Background: The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic (LIHR) and open (OIHR) inguinal hernia repair. Methods: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials that compared OIHR and LIHR and were published in the English language between January 1990 and the end of October 2000. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed were operating time, time to discharge from hospital, return to normal activity and return to work, postoperative complications and recurrence rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences. Results: Twenty-nine trials were considered suitable for meta-analysis. Some 3017 hernias were repaired laparoscopically and 2972 hernias were repaired using an open method in 5588 patients. For four of the six outcomes the summary point estimates favoured LIHR over OIHR; there was a significant reduction of 38 per cent in the relative odds of postoperative complications (odds ratio 0·62 (95 per cent confidence interval (c.i.) 0·46 to 0·84); P = 0·002), 4·73 (95 per cent c.i. 3·51 to 5·96) days in time to return to normal activity (P < 0·001), 6·96 (95 per cent c.i. 5·34 to 8·58) days in time to return to work (P < 0·001) and 3·43 (95 per cent c.i. 0·35 to 6·50) h in time to discharge from hospital (P = 0·029). There was a significant increase of 15·20 (95 per cent c.i. 7·78 to 22·63) min in the mean operating time for LIHR (P < 0·001). The relative odds of short-term recurrence were increased by 50 per cent for LIHR compared with OIHR, although this result was not statistically significant (odds ratio 1·51 (95 per cent c.i. 0·81 to 2·79); P = 0·194). Conclusion: LIHR was associated with earlier discharge from hospital, quicker return to normal activity and work, and significantly fewer postoperative complications than OIHR. However, the operating time was significantly longer and there was a trend towards an increase in the relative odds of recurrence after laparoscopic repair.