Meta-analysis of laparoscopic inguinal hernia trials favors open hernia repair with preperitoneal mesh prosthesis

Background: This meta-analysis was performed to determine the degree to which improvements in open hernia repair (OHR) in the last decade have altered the relative benefit of laparoscopic hernia repair (LHR). Methods: Twenty-seven comparative trials including 4,688 randomized patients were evaluated. Results: Within the control OHR, patients with routine mesh repair returned to work earlier than a sutured repair (16.4 versus 27.3 days, P = 0.010). During the study period, the increased use of mesh in OHR (3 of 12 initially versus 9 of 15 subsequent studies) was associated with an earlier return to work (25.9 to 16.8 days, P = 0.017); there was no significant improvement with corresponding LHR. Conclusions: Although LHR was associated with an earlier return to work compared with conventional sutured OHR, more recent mesh OHRs provide equivalent outcomes but at lower costs and potentially less severe complications, supporting an open technique using preperitoneal mesh prostheses as the optimal hernia repair