Efficacy of laparoscopic versus traditional open component separation technique in the treatment of adult abdominal wall hernia-A meta-analysis

doi:10.3877/cma.j.issn.1674-392X.2025.02.022

Abstract

Abstract:

Objective

To evaluate the clinical efficacy of minimally invasive laparoscopy and traditional open component separation technique (CST) in the treatment of adult (≥18 years of age)abdominal wall hernia.

Methods

PubMed, Medline, Embase, Cochrane Library, Web of Science, VIP information Chinese periodical database, CBM, CNKI and Wanfang Med Online were searched from the establishment of the database to August 1, 2023, and the language of literature was not limited.All controlled clinical trials comparing minimally invasive laparoscopic with traditional open CST for abdominal wall hernia in adults were collected.The data were extracted and cross-checked by two reviewers independently according to the pre-established inclusion criteria.The statistical analysis was performed using RevMan5.4 software provided by the Cochrane website.

Results

A total of 12 articles involving 754 patients were included in this study.Meta-analysis results showed that the minimally invasive laparoscopic CST group was better than the traditional open CST group in terms of postoperative recurrence rate (OR=0.59, 95% CI 0.38-0.92, P=0.02), postoperative complication rate (OR=0.19, 95% CI 0.10-0.34, P<0.000 01), intraoperative blood loss (MD=-45.81, 95% CI -61.56--30.06, P<0.000 01) and postoperative hospital stay (MD=-2.15, 95% CI -3.63--0.67, P=0.004), the differences were statistically significant.However, the operation time of the minimally invasive laparoscopic CST group was longer than that of the traditional open CST group (MD=16.13, 95% CI 2.77-29.48, P=0.02), the difference was statistically significant.

Conclusion

Compared with traditional open CST, minimally invasive laparoscopic CST has advantages in postoperative recurrence rate, postoperative complications, intraoperative blood loss and postoperative hospital stay, but its operation time is slightly longer.

Key words: Hernia, abdominal, Herniorrhaphy, Component separation technique, Laparoscopes, Meta-analysis

Jiangqiao Zhao, Shuo Yang. Efficacy of laparoscopic versus traditional open component separation technique in the treatment of adult abdominal wall hernia-A meta-analysis[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 232-240.

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Figures/Tables 12

References 28

[1]	顾岩, 杨建军, 宋致成, 等.腹壁疝组织结构分离技术的进展和改革[J].临床外科杂志, 2019, 27(9): 739-742.
[2]	Sauerland S, Schmedt CG, Lein S, et al.Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up[J].Langenbecks Arch Surg, 2005, 390(5):408-412.
[3]	Burger JW, Luijendijk RW, Hop WC, et al.Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia[J].Ann Surg, 2004, 240(4): 578-583; discussion583-585.
[4]	Lomanto D, Iyer SG, Shabbir A, et al.Laparoscopic versus open ventral hernia mesh repair: a prospective study[J].Surg Endosc,2006, 20(7): 1030-1035.
[5]	Novitsky YW, Porter JR, Rucho ZC, et al.Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias[J].J Am Coll Surg, 2006, 203(3): 283-289.
[6]	Ramirez OM， Ruas E， Dellon AL.“Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study[J].Plast Reconstr Surg, 1990, 86(3): 519-526.
[7]	de Vries Reilingh TS， van Goor H， Rosman C， et al.“Components separation technique” for the repair of large abdominal wall hernias[J].J Am Coll Surg, 2003, 196(1): 32-37.
[8]	Maas SM, de Vries RS, van Goor H, et al.Endoscopically assisted“components separation technique” for the repair of complicated ventral hernias[J].J Am Coll Surg, 2002, 194(3): 388-390.
[9]	Liberati A, Altman DG, Tetzlaff J, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration[J].J Clin Epidemiol, 2009, 62(10): e1-34.
[10]	Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol, 2010, 25(9): 603-605.
[11]	Lowe JB, Garza JR, Bownmn JL, et al.Endoscopically assisted“components separation” for closure of abdominal wall defects[J].Plast Reconstr Surg, 2000, 105(2): 720-729; quiz 730.
[12]	Harth KC, Rosen MJ.Endoscopic versus open component separation in complex abdominal wall reconstruction[J].Am J Surg, 2010,199(3): 342-346; discussion 346-347.
[13]	Albright E, Dias D, Davenport D, et a1.The component separation technique for hernia repair: a comparison of open and endoscopic techniques[J].Am Surg, 2011, 77(7): 839-843.
[14]	Giurgius M, Bendure L, Davenport DL, et a1.The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique[J].Hernia, 2012, 16(1): 47-51.
[15]	Fox M, Cannon RM, Egger M, et a1.Laparoscopic component separation reduces postoperative wound complications but does not alter recurrence rates in complex hernia repairs[J].Am J Surg, 2013,206(6): 869-874; discussion 874-875.
[16]	Azoury SC, Dhanasopon AP, Hui X, et al.A single institutional comparison of endoscopic and open abdominal component separation[J].Surg Endosc, 2014, 28(12): 3349-3358.
[17]	Nathaniel Ng, Mallory Wampler, Humberto Palladino, et al.Outcomes of laparoscopic versus open fascial component separation for complex ventral hernia repair[J].Am Surg, 2015, 81(7): 714-719.
[18]	Muse TO, Zwischenberger BA, Miller MT, et al.Outcomes after ventral hernia repair using the rives-stoppa, endoscopic, and open component separation techniques[J].Am Surg, 2018, 84(3): 433-437.
[19]	Palmer DS, McDaniel CC, Samra NS, et al.Comparing surgical site infection for open and endoscopic component separation[J].Am Surg, 2019, 85(4): 350-352.
[20]	陈正民, 周少波, 贲大刚, 等.腹腔镜与开放组织结构分离技术治疗腹壁疝临床疗效比较[J].蚌埠医学院学报, 2019, 44(4):476-480.
[21]	李冬.开放与腹腔镜下组织结构分离技术在腹壁疝治疗中的应用效果比较[J].中国实用医刊, 2021, 48(7): 70-72.
[22]	李权军.开放与腹腔镜下组织结构分离技术在腹壁疝治疗中的效果观察[J].长寿,2023(2):48-49,52.
[23]	Ross SW, Oommen B, Huntington C, et al.National outcomes for open ventral hernia repair techniques in complex abdominal wall reconstruction[J].Am Surg, 2015, 81(8): 778-785.
[24]	Bisgaard T, Bay-Nielsen M, Kehlet H.Re-recurrence after operation for recurrent inguinal hernia: a nationwide 8-year follow-up study on the role of type of repair[J].Ann Surg, 2008, 247(4): 707-711.
[25]	Milburn ML, Shah PK, Friedman EB, et al.Laparoscopically assisted components separation technique for ventral hernia repair[J].Hernia,2007, 11(2): 157-161.
[26]	Maloney SR, Schlosser KA, Prasad T, et al.Twelve years of component separation technique in abdominal wall reconstruction[J].Surgery, 2019, 166(4): 435-444.
[27]	Cornette B, De Bacquer D, Berrevoet F.Component separation technique for giant incisional hernia: a systematic review[J].Am J Surg, 2018, 215(4): 719-726.
[28]	蔡宗达.腔镜与开放组织结构分离技术治疗腹壁疝的Meta 分析[D].福州: 福建医科大学, 2014: 1-30.

作者	发表时间	国家	研究类型	研究时间	总样本量(例)	腹腔镜组(例)	开放组(例)	文献质量评分(分)
Lowe JB 等^[11]	2000	美国	回顾性研究	1994-1997	37	7	30	7
Harth KC 等^[12]	2010	美国	回顾性研究	2005-2009	44	22	22	8
Albright E 等^[13]	2011	美国	回顾性研究	2008-2010	25	11	14	7
Giurgius M 等^[14]	2012	法国	回顾性研究	2008-2010	35	21	14	7
Fox M 等^[15]	2013	美国	回顾性研究	2009-2011	44	18	26	8
Azoury SC 等^[16]	2014	美国	前瞻性研究	2010.10-2013.7	76	42	34	9
Nathaniel Ng 等^[17]	2015	美国	回顾性研究	2009-2013	48	10	38	7
Muse TO 等^[18]	2018	美国	回顾性研究	2006.1-2011.12	170	53	117	8
Palmer DS 等^[19]	2019	美国	回顾性研究	2011.11-2018.4	33	9	24	8
陈正民等^[20]	2019	中国	回顾性研究	2014-2017	116	58	58	7
李冬^[21]	2021	中国	回顾性研究	2015.10-2019.11	58	33	25	7
李权军^[22]	2023	中国	前瞻性研究	2020.10-2022.4	68	34	34	7

作者	发表时间	国家	研究类型	研究时间	总样本量(例)	腹腔镜组(例)	开放组(例)	文献质量评分(分)
Lowe JB 等^[11]	2000	美国	回顾性研究	1994-1997	37	7	30	7
Harth KC 等^[12]	2010	美国	回顾性研究	2005-2009	44	22	22	8
Albright E 等^[13]	2011	美国	回顾性研究	2008-2010	25	11	14	7
Giurgius M 等^[14]	2012	法国	回顾性研究	2008-2010	35	21	14	7
Fox M 等^[15]	2013	美国	回顾性研究	2009-2011	44	18	26	8
Azoury SC 等^[16]	2014	美国	前瞻性研究	2010.10-2013.7	76	42	34	9
Nathaniel Ng 等^[17]	2015	美国	回顾性研究	2009-2013	48	10	38	7
Muse TO 等^[18]	2018	美国	回顾性研究	2006.1-2011.12	170	53	117	8
Palmer DS 等^[19]	2019	美国	回顾性研究	2011.11-2018.4	33	9	24	8
陈正民等^[20]	2019	中国	回顾性研究	2014-2017	116	58	58	7
李冬^[21]	2021	中国	回顾性研究	2015.10-2019.11	58	33	25	7
李权军^[22]	2023	中国	前瞻性研究	2020.10-2022.4	68	34	34	7

作者	手术方式	年龄(中位数)	男性	女性	体重指数(kg/m²)	缺损面积(cm²)	随访时长(个月)
Lowe JB 等^[11]	腹腔镜CST	53	3	4	35.5	288	12
	开放CST	45	15	15	33.2	209	12
Harth KC 等^[12]	腹腔镜CST	55	13	9	36	324	14
	开放CST	65	7	15	37	392	16
Albright E 等^[13]	腹腔镜CST	46	5	6	37.5	-	4
	开放CST	50	7	7	34.8	-	4
Giurgius M 等^[14]	腹腔镜CST	51	10	11	36	255	8
	开放CST	50	7	7	35	146	-
Fox M 等^[15]	腹腔镜CST	57	9	9	34	-	13
	开放CST	51	13	13	32	-	15
Azoury SC 等^[16]	腹腔镜CST	56	15	27	34.2	120	8
	开放CST	50	9	25	40.9	262.5	10
Nathaniel Ng 等^[17]	腹腔镜CST	48.7	-	-	37.5	102.7	15
	开放CST	50.8	-	-	31.3	226.9	37
Muse TO 等^[18]	腹腔镜CST	54.4	21	32	35.3	313	12.7
	开放CST	50.2	51	66	31.4	-	14.3
Palmer DS 等^[19]	腹腔镜CST	53	5	4	32.7	108.5	5.7
	开放CST	51	10	14	34.6	138.2	5
陈正民等^[20]	腹腔镜CST	45	30	28	-	-	6
	开放CST	44	31	27	-	-	6
李冬^[21]	腹腔镜CST	42	19	14	-	-	-
	开放CST	41	14	11	-	-	-
李权军^[22]	腹腔镜CST	41	17	17	-	-	-
	开放CST	40	18	16	-	-	-

作者	手术方式	年龄(中位数)	男性	女性	体重指数(kg/m²)	缺损面积(cm²)	随访时长(个月)
Lowe JB 等^[11]	腹腔镜CST	53	3	4	35.5	288	12
	开放CST	45	15	15	33.2	209	12
Harth KC 等^[12]	腹腔镜CST	55	13	9	36	324	14
	开放CST	65	7	15	37	392	16
Albright E 等^[13]	腹腔镜CST	46	5	6	37.5	-	4
	开放CST	50	7	7	34.8	-	4
Giurgius M 等^[14]	腹腔镜CST	51	10	11	36	255	8
	开放CST	50	7	7	35	146	-
Fox M 等^[15]	腹腔镜CST	57	9	9	34	-	13
	开放CST	51	13	13	32	-	15
Azoury SC 等^[16]	腹腔镜CST	56	15	27	34.2	120	8
	开放CST	50	9	25	40.9	262.5	10
Nathaniel Ng 等^[17]	腹腔镜CST	48.7	-	-	37.5	102.7	15
	开放CST	50.8	-	-	31.3	226.9	37
Muse TO 等^[18]	腹腔镜CST	54.4	21	32	35.3	313	12.7
	开放CST	50.2	51	66	31.4	-	14.3
Palmer DS 等^[19]	腹腔镜CST	53	5	4	32.7	108.5	5.7
	开放CST	51	10	14	34.6	138.2	5
陈正民等^[20]	腹腔镜CST	45	30	28	-	-	6
	开放CST	44	31	27	-	-	6
李冬^[21]	腹腔镜CST	42	19	14	-	-	-
	开放CST	41	14	11	-	-	-
李权军^[22]	腹腔镜CST	41	17	17	-	-	-
	开放CST	40	18	16	-	-	-

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