Laparoscopic surgery versus open surgery for prevention of incisional hernia: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES: Incisional hernia remains a significant complication following abdominal surgery, with the incidence ranging from 5% to 20%. This systematic review compared the incidence of incisional hernia incidence between laparoscopic and open surgical approaches and identified effect modifiers. MATERIALS AND METHODS: We searched PubMed, Cochrane Library, Embase, Web of Science, and SCOPUS for studies published from January 2000 to December 2023. This review was not registered in PROSPERO, representing a methodological limitation. Randomized controlled trials (RCTs) and observational studies comparing laparoscopic versus open surgery with a minimum 6-month follow-up were included. Risk of bias was assessed using Cochrane risk of bias 2.0 and Newcastle–Ottawa Scale. Random-effects meta-analysis calculated risk ratios (RR) with 95% confidence intervals (CI). RESULTS: Twenty-eight studies (15 RCTs, 13 observational) comprising 14,567 patients were analyzed. Laparoscopic surgery demonstrated significantly lower incisional hernia risk (RR = 0.62, 95% CI: 0.51–0.75, P < 0.001; I2 = 45%). Benefits were consistent across colorectal (RR = 0.58), ventral hernia repair (RR = 0.55), and bariatric procedures (RR = 0.67). Meta-regression revealed stronger protective effects with higher body mass index (P = 0.03). Benefits persisted across follow-up periods and detection methods. CONCLUSION: Laparoscopic approaches significantly reduce incisional hernia risk across diverse abdominal procedures, with effects particularly pronounced in patients with obesity. These findings should inform surgical approach selection and patient counseling, though limitations include lack of protocol registration and limited representation of contemporary robotic techniques.