切開ヘルニア修復術における開放術と腹腔鏡下手術の比較：ランダム化比較試験の系統的レビューとメタアナリシス

The choice between open and laparoscopic techniques for incisional hernia repair remains debated in surgical practice. This systematic review and meta-analysis was aimed at comparing the clinical outcomes of open versus laparoscopic incisional hernia repair in adults, with a focus on postoperative complications, recurrence, recovery, and patient satisfaction.

A comprehensive literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) comparing open and laparoscopic repair of incisional hernias were included. The main outcomes were postoperative complications (wound infection, hematoma, seroma, ileus, and sepsis), recurrence rates, time to recovery, and quality of life. A total of 726 patients from studies conducted in Europe and the United States were included: 365 in the open surgery group and 361 in the laparoscopic group.

The meta-analysis revealed no statistically significant differences between techniques regarding overall postoperative complications, recurrence rates, or quality-of-life scores. Although the rate of wound infection and the incidence of ileus were slightly lower in the laparoscopic group than the open surgery group, the differences were not statistically significant. Additionally, the recurrence rates were ‏comparable between approaches (risk ratio = 1.00, 95 % CI: 0.64-1.57). However, seroma formation exhibited significant heterogeneity across studies. ‏Laparoscopic repair was associated with faster recovery and better long-term quality of life, particularly physical and emotional well-being.

This systematic review and meta-analysis demonstrated no significant differences in primary clinical outcomes between open and laparoscopic incisional hernia repair techniques. Both approaches had comparable complication and recurrence rates. However, laparoscopic repair might provide advantages of faster recovery and improved postoperative quality of life, and therefore is a viable alternative to open repair for suitable candidates. Further studies with larger sample sizes and standardized protocols are necessary to confirm these findings.