SP7.2.2 Fascial defect closure in laparoscopic incisional/ventral hernia: a systematic review and meta-analysis of published randomized, controlled trials

Abstract

Abstract Aims Closure of fascial defect (CFD) during laparoscopic incisional/ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR. Methods A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z = 0.21; P = 0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z = 1.41; P = 0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z = 0.18; P = 0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z = 1.80; P = 0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z = 2.95; P = 0.003). Conclusion Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.