腹壁ヘルニア修復における腹腔鏡下手術対開腹手術の比較転帰：システマティックレビューおよびメタアナリシス

A hernia is the abnormal protrusion of a viscus through a defect in the surrounding wall. Laparoscopic repair is increasingly favored over open surgery for ventral hernias due to its minimally invasive approach. However, consolidated evidence comparing their outcomes remains limited.

This study aimed to compare outcomes including surgical site infection, hospital stay, operative time, and hernia recurrence between laparoscopic and open ventral hernia repair in adult patients, using evidence from randomized controlled trials and cohort studies.

We systematically searched PubMed, Embase, and the Cochrane Library from 2000 to the current year. Eligible studies included randomized controlled trials and observational (prospective or retrospective cohort) studies comparing laparoscopic and open ventral hernia repair in adults (≥18 years) and reporting at least one of the outcomes of interest. Studies were excluded if they focused on pediatric populations, assessed only one outcome, or were case reports, meta-analyses, reviews, editorials, or studies addressing only inguinal/incisional hernias without specifying inclusion under ventral hernias. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle-Ottawa Scale. Considering the included studies differed in clinical characteristics such as hernia type, defect size, mesh materials, fixation techniques, and surgeon experience a random effects model was selected before analysis as the most appropriate statistical approach, A random-effects meta-analysis was conducted and results presented narratively and using forest plots.hig.

Nineteen studies (3 RCTs and 16 cohort studies; 7,826 patients) were included. Laparoscopic repair significantly reduced the risk of surgical site infection (RR = 0.36, 95% CI: 0.24-0.53) and shortened hospital stay (mean difference = -2.02 days, 95% CI: -2.15 to -1.89). Operative time was modestly longer with laparoscopy (mean difference= 9.44 minutes, 95% CI: 6.74 to 12.15). No significant difference in hernia recurrence was observed (RR = 1.03, 95% CI: 0.80-1.32). High heterogeneity was observed for hospital stay and operative time (I²= 98-99%), Subgroup analyses by hernia type and mesh placement were conducted to explore potential sources of variability. Funnel plot asymmetry suggested possible publication bias for hospital stay.

Laparoscopic ventral hernia repair appears to be associated with reduced surgical site infection and shorter hospitalization, without increasing recurrence risk. Some of these findings however must be interpreted with caution given the substantial heterogeneity observed in operative time and hospital stay. Variability in outcome reporting and study design also limits generalizability of the findings.