Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: A systematic review

Surgical Endoscopy And Other Interventional Techniques - Tập 21 - Trang 2127-2136 - 2007
Falk Müller-Riemenschneider1, Stephanie Roll1, Meik Friedrich2, Juergen Zieren3, Thomas Reinhold1, J.-Matthias Graf von der Schulenburg2, Wolfgang Greiner4, Stefan N. Willich1
1Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
2Centre for Health Economics and Health System Research, Leibniz University Hannover, Germany
3Department for General, Vascular and Thoracic Surgery, Charité University Medical Center, Berlin, Germany
4Health Economics and Health Care Management, University of Bielefeld, Berlin, Germany

Tóm tắt

Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of laparoscopic surgery is increasing. It therefore remains uncertain which technique should be recommended as the standard of care. To compare the medical effectiveness and safety of conventional mesh and laparoscopic incisional hernia repair. A structured literature search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI) was conducted. English and German literature published until August 2005 was included and their methodological quality assessed. The search identified 17 relevant publications and included 15 studies for final assessment. Among those were one meta-analysis, one randomized clinical trial (RCT) ,and 13 cohort studies. All studies suffered from significant methodological limitations, such as differences in baseline characteristics between treatment groups, small case numbers, and the lack of adjustment for relevant confounders. Overall, medical effectiveness and safety were similar for both surgical approaches. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative pain as well as decreased complication rates for the laparoscopic repair in the majority of studies. The impact of the technique of mesh implantation and mesh fixation as well as the impact of certain patien- related factors was not systematically assessed in any of the studies. No conclusive differences could be identified between the operative techniques. There was, however, some evidence for a trend towards similar or slightly improved outcomes associated with the laparoscopic procedure. There remains an urgent need for high-quality prospective studies to evaluate this question conclusively.

Tài liệu tham khảo

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Surgical Endoscopy And Other Interventional Techniques

Tập 21

2127-2136

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