Laparoscopic versus open groin hernia repair in older adults: a systematic review and meta‐analysis

Abstract

Background: Groin hernia repair is a common surgical procedure and includes both open and laparoscopic techniques. Studies comparing outcomes of laparoscopic versus open groin hernia repair specifically in the geriatric population are lacking. This study compares the outcomes of laparoscopic versus open groin hernia repair techniques in older adults. Methods: A literature search was conducted in each of the five selected databases up till June 2021: PubMed (MEDLINE), EMBASE, CINAHL, Cochrane and PsychInfo (OVID).Outcomes measured included but were not limited to total length of hospital stay, mean total operative time, intraoperative complications, post-operative complications such as wound infection, seroma formation, chronic pain, mesh infection and recurrence of inguinal hernia. Results: A total of five articles were included in the final analysis. The length of postoperative hospitalization stay was shorter in patients who underwent laparoscopic hernia repair (95% CI: À1.50 to À0.72; P < 0.01, I 2 = 79%). The laparoscopic repair group had a significantly smaller number of patients who sustained postoperative wound infections (95% CI: 0.02 to 0.47; P = 0.003, I 2 = 0%), and lower incidence of chronic pain (95% CI: 0.14 to 0.37, P < 0.01, I 2 = 46%). Analysis of the remaining outcomes did not reveal any statistically significant differences between open and laparoscopic hernia repair. Conclusions: The results of this analysis showed a shorter length of stay, lower wound infection rates and lower chronic pain with laparoscopic groin hernia repair as compared to open repair in older adults. Future prospective studies examining the impact of age on the relationship between surgical approach (open versus laparoscopic) and surgical outcomes are needed.

Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia

“…Traditionally, open and laparoscopic techniques have been the primary methods for inguinal hernia repair [ 27 ]. Laparoscopic hernia repair has gained significant attention from surgeons and patient preference due to its advantages, including reduced trauma, lower infection rates, and shorter postoperative recovery times [ 28 ]. The introduction of robotic surgical systems has greatly advanced the field of minimally invasive surgery [ 29 ].…”

Laparoscopic versus open inguinal hernia repair in aging patients: A propensity score matching-based retrospective study

“…There was no mortality in both groups. As described, compared to OIHR (LTFR), LIHR has the advantages of lower incidence of hematoma, lower rates of seroma, less postoperative pain, faster recovery and less wound infection rate [4,29] , which are also applicable to elderly patients [11,12] . After PSM, there were no signi cant differences in baseline between LIHR and OIHR groups (Table 1, 2).…”

“…Although no prospective studies have reported the correlation between age, surgical methods (LIHR and OIHR), and surgical outcomes. A retrospective study found that in the treatment of inguinal hernia repair in elderly patients, LIHR also showed similar advantages [11] .…”

Better and cheaper by day! Most inguinal herniorrhaphy patients are suitable for day‐stay repair regardless of surgical approach

“…The perspective 1 also raises the important topic of the cost of deliver in surgical services, in particular the cost of laparoscopic inguinal herniorrhaphy, given that open and laparoscopic approaches have similar outcomes 3 . This edition of the journal also publishes two articles showing not dis‐similar outcomes in the elderly 4 and in infants 5 . Cost is not only influenced by the method of repair (open, laparoscopic or robotic) and equipment used, but also by the model of care, especially whether the procedure involves a day stay or overnight stay.…”

“…Safety, quality of care and patient experience are not compromised when appropriate patients are selected and clear expectations of same-day discharge are set and agreed. The outcomes of hernia surgery are similar regardless of the approach used, [3][4][5][6] so surgeons should feel free to choose an approach, whether open or laparoscopic, based on their experience and which can be performed safely, aiming to achieve the best outcome for their patients.…”