Laparoscopic compared with open methods of groin hernia repair: systematicreview of randomized controlled trials

Background: The place of laparoscopic groin hernia repair remains controver sial. Individual randomized controlled trials alone have not provided stati stically reliable results when considering recurrence, potentially serious complications and chronic pain. Methods: A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases we re searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and , where possible, quantitative meta-analysis was performed. Results: Thirty-four published reports of eligible trials were included, in volving 6804 participants. Sample sizes ranged from 20 to 1051, with follow -up from 6 weeks to 36 months. Duration of operation was longer in the lapa roscopic groups (P < 0.001, Sign test). Operative complications were uncomm on for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4.7 per 1000 versus 1.1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0.08). Length of hospital sta y did not differ significantly between groups (P = 0.50), but return to usu al activity was earlier for laparoscopic groups (P < 0.001). Chronic pain a nd numbness were reported for only a small minority of trials. Overall, rec urrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for t ransabdominal preperitoneal repair (Peto odds ratio 0.56 (95 per cent confi dence interval 0.33-0.93); P = 0.026). Conclusion: Although the rigorous search maximized trial identification, va riation in trial reporting made formal meta-analysis difficult. Laparoscopi c repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the r isk of rare, but serious, complications.