Meta-analysis of patient-reported outcomes after laparoscopic versus open inguinal hernia repair

Abstract

Background: Inguinal hernia repair is a common low-risk intervention. Patient-reported outcomes (PROs) are being used increasingly as primary outcomes in clinical trials. The aim of this study was to review and meta-analyse the PROs in RCTs comparing laparoscopic versus open inguinal hernia repair techniques in adult patients.Methods: A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. Only RCTs in peer-reviewed journals were considered. PubMed, Ovid Embase, Scopus and the Cochrane Library were searched. In addition, four trial registries were searched. The search interval was between 1 January 1998 and 1 May 2018. Identified publications were reviewed independently by two authors. The review was registered in the PROSPERO database (CRD42018099552). Bias was assessed using the Cochrane Collaboration risk-of-bias tool.Results: Some 7192 records were identified, from which 58 unique RCTs were selected. Laparoscopic hernia repair was associated with significantly less postoperative pain in three intervals: from 2 weeks to within 6 months after surgery (risk ratio (RR) 0⋅74, 95 per cent c.i. 0⋅62 to 0⋅88), 6 months to 1 year (RR 0⋅74, 0⋅59 to 0⋅93) and 1 year onwards (RR 0⋅62, 0⋅47 to 0⋅82). Paraesthesia (RR 0⋅27, 0⋅18 to 0⋅40) and patient-reported satisfaction (RR 0⋅91, 0⋅85 to 0⋅98) were also significantly better in the laparoscopic repair group. Conclusion:The data and analysis reported in this study reflect the most up-to-date evidence available for the surgeon to counsel patients. It was constrained by heterogeneity of reporting for several outcomes. Summary measures and synthesis of resultsPROs are shown as crude rates and, if appropriate, mean scores. Meta-analysisMeta-analysis was undertaken for each distinct outcome if there were two or more RCTs that examined the same

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