Open Versus Laparoscopic Incisional Hernia Repair Following Liver Transplantation: An Updated Systematic Review and Meta-Analysis.

Abstract

Background: Incisional hernias (IHs) represent a frequently encountered postoperative complication in patients undergoing liver transplantation. Traditionally, these hernias have been addressed through open surgical techniques. However, laparoscopic repair has been increasingly recognized for its association with a reduced complication rate in the management of ventral hernias. Our objective is to conduct a comparative analysis of the outcomes associated with open versus laparoscopic repair techniques in liver transplant recipients. Methods: We conducted a comprehensive literature review across multiple databases, including PubMed, Cochrane, LILACS, SciELO, and EMBASE, to identify studies that compare the efficacy of open and laparoscopic repair methods for IHs postliver transplantation. For the statistical analysis of gathered data, we used the Review Manager software, version 5.4. To evaluate the variability among the study outcomes, we assessed heterogeneity using the I² statistic. Results: After an initial screening of 334 studies, 6 studies with a combined total of 338 patients fulfilled our inclusion criteria. Our analysis revealed that laparoscopic repair tends to be associated with longer operation times, with a mean difference of 20.30 minutes (confidence interval [CI]: 2.14-38.46; P = .03). We observed no significant differences between laparoscopic and open repair regarding infection rates, recurrence rates, overall surgical complications, or hospital stay duration. Conclusion: Both surgical approaches yield comparable postoperative outcomes. However, laparoscopic repair is associated with an increased operation time duration. To substantiate these findings, further research involving prospective, randomized studies is necessary.