Comparison of laparoscopic versus open incisional hernia repair
- 45 trials between 1996 and 2006
– 14 comparative trials (laparoscopic versus open surgery)
– 31 prospective and retrospective trials
- Laparoscopic – open: n=4582 – n= 758
- Follow-up laparoscopic – open: 25.5 months – 20.2 months
Results:
– Rate of wound infections (%) 1.3: 10.4 p < 0.0001 - rate of wound complications (%) 3.8: 16.8 p < 0.0001 - rate of mesh infections (%) 0.9: 3.2 p < 0.0001 - recurrence rate (%) 4.3: 12.1 p < 0.0001
- Summary: The laparoscopic technique demonstrates convincing results regarding the rates for recurrence and complications. Particularly its rate of infection is markedly lower when compared with the open technique.
Comparison of abdominal wall closure in midline laparotomy – interrupted versus continuous suture
- Randomized multicenter trial in 625 patients
– 3 groups: Interrupted suture with vicryl, continuous suture with PDS, continuous suture with Monoplus
– clinical examination and by ultrasonography
Result:
– incidence of incisional hernias 12.3%
– no difference between the groups
– incidence of wound infection 16.1%
– no difference between the groups
– BMI (body mass index) is the sole risk factor for incisional hernia formation
– wound infection, age, smoking, previous laparotomies are irrelevant!
- Summary: The number of incisional hernias and wound infections was rather surprising and this demands new concepts in their prevention.
- Such high incidences mandate the best incisional hernia repair possible!