Comparison of open and laparoscopic groin hernia repair in elderly patients or octogenarians, an updated systematic...

In recent years, the incidence of inguinal hernia in the elderly has been gradually increasing. Due to the frequent occurrence of multiple comorbidities and high surgical risks in elderly patients with inguinal hernia, the implementation of inguinal hernia repair surgery has certain particularities, including both traditional open repair and laparoscopic repair. Currently, there are no specific guidelines for the treatment of inguinal hernia in the elderly. The main purpose of this study was to compare the therapeutic effects of laparoscopic and open repair in elderly patients or octogenarians with inguinal hernia, thereby assisting clinical treatment.

In this meta-analysis, studies comparing open and laparoscopic inguinal hernia repair in elderly patients or octogenarians were identified by searching the PubMed, Cochrane, and Web of Science databases. The pooled effect size was assessed using odds ratio (OR), risk difference (RD), mean difference (MD), and 95% confidence intervals (95% CI). In addition, postoperative complications, including both surgical-related and systemic complications, operative time, length of hospital stay, and recurrence rate, were analyzed as outcome measures.

Ten cohort studies and two randomized trials containing 2158 elderly patients or octogenarians were included in the analysis. In elderly patients aged over 65 years with inguinal hernia, no significant differences were observed between the open and laparoscopic groups concerning minor complications (P = 0.41), major complications (P = 0.09), surgical-site complications (P = 0.63), systemic complications (P = 0.70), overall complications (P = 0.36), operative time (P = 0.61), or recurrence rate (P = 0.66), however, the length of hospital stay in the open group was found to be significantly longer than that in the laparoscopic group (MD: 1.30, 95% CI 0.53-2.08, P = 0.0009). Importantly, among octogenarians, the incidence of systemic complications in the laparoscopic group was observed to be significantly higher than that in the open group (OR 0.39, 95% CI 0.17-0.94, P = 0.03). However, no significant differences were found between the open and laparoscopic groups in overall complications (P = 0.48), surgical-site-related complications (P = 0.59), minor complications (P = 0.15), and major complications (P = 0.37) in patients aged over 80 years old.

In elderly patients aged over 65 years with inguinal hernia, the length of hospital stay in the open group was found to be significantly longer than that in the laparoscopic group, and no significant differences were found in the other postoperative outcomes between the two groups. Notably, in patients aged over 80 years, the incidence of systemic complications in the laparoscopic group was observed to be significantly higher than that in the open group, but the complication severity was not significantly different between the two groups.