Comparing Laparoscopic Versus Open Repair of Recurrent Incisional Hernia: An Updated Systematic Review and Meta‐Analysis of Randomized Controlled Studies on Recurrence and Complications

BACKGROUND: Incisional hernia is the most common postoperative complication of abdominal wall surgery that significantly increases morbidity. We aimed to evaluate recurrence rates and perioperative outcomes associated with Laparoscopic and open repair for Incisional hernia recurrence. METHODS: A comprehensive and systematic literature search was conducted across PubMed, Embase, CINAHL Ultimate, Medline, Scopus, and the Cochrane Controlled Trials Register. Studies published between July 2013, and November 2024 were screened for inclusion. The data extracted included recurrence rates, surgical complications, bowel injury, and outcomes. Pooled risk ratios (RR) were calculated to compare the outcomes of Laparoscopic repair and Open repair. Statistical analysis was performed using STATA V17 using a random-effects model. RESULTS: A total of 15 randomized controlled trials (RCTs), encompassing 1502 patients from nine countries, met the eligibility criteria. The analysis revealed no significant difference in recurrence rates between LR and OR. However, LR was associated with a significantly lower likelihood of wound drainage (RR = 0.07, 95% CI: 0.04-0.15) and a reduced risk of postoperative infection (RR = 0.31, 95% CI: 0.17-0.55) compared to OR. Conversely, the risk of bowel injury (RR = 2.80, 95% CI: 1.15-6.80, p = 0.02), indicating that patients undergoing LR were nearly three times more likely to experience bowel injury than those undergoing OR. CONCLUSION: Laparoscopic repair of incisional hernias offers several advantages over open repair, including lower rates of wound infection. However, it is associated with a higher risk of bowel injury, necessitating careful patient selection and surgical expertise.