Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs

Background: Despite randomized controlled trials, the merits of laparoscopi c hernia repair remain poorly defined. A meta-analysis may provide a timely overview. Methods: An electronic MEDLINE search, supplemented by a manual search, yie lded 14 randomized controlled trials with usable statistical data, involvin g 2,471 patients. The trials were grouped for separate meta-analyses accord ing to the control operation, either a tension-free or sutured repair, used for comparison. The effect sizes for operating time, postoperative pain, r eturn to normal activity, and early recurrence were calculated, using a ran dom-effects model when the effect sizes were heterogeneous and without subc ategories. Results: In all meta-analyses, the laparoscopic operation was significantly longer. When compared with tension-free repairs, the laparoscopic operatio n showed no advantage in terms of postoperative pain, but resulted in a sho rter recovery (marginal significance). As compared with sutured repair, bot h postoperative pain and recovery were in favor of the laparoscopic operati on. When all 14 trials were analyzed together, laparoscopic repairs still h ad moderately reduced postoperative pain and recovery time. Conclusions: Laparoscopic hernia repair has a modest advantage over convent ional repairs. This advantage is more apparent when laparoscopic repairs ar e compared with sutured repairs rather than tension-free repairs.