Comment to: Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Awaiz A et al. Hernia 2015;19:449-463.

Abstract

It was with concern we read the article ‘‘Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia’’ by Awaiz et al. [1]. In this review and meta-analysis, laparoscopic and open approach for incisional hernia repair were compared. The authors concluded erroneously that these two approaches were comparable in terms of short-term complications. We believe this conclusion to be wrong, based on an error in the meta-analysis of postoperative wound infections. The authors appeared to have switched the numbers between the laparoscopic and open group in the study by Itani et al., leaving 17/73 with a wound infection after laparoscopic repair and 3/73 after open repair, in contrast to what was indeed reported in the original article [2]. After insertion of the correct numbers, laparoscopic incisional hernia repair is found to lead to significantly fewer wound infections as compared with open approach (odds ratio 0.19, 95 % confidence interval 0.06–0.61, p = 0.005, Fig. 1). This is in agreement with a Cochrane review on the same topic published in 2011 [3]. Furthermore, we found it troubling that the authors conducted a meta-analysis on an outcome registered prior to the intervention that was performed: Preoperative hernia diameter was not affected by randomized allocation of surgical approach.