Six trials met the inclusion criteria, but only four prospective trials were included in meta-analyses (n=404 patients). The quality score of trials ranged from 2 to 3 points. The mean duration of follow-up ranged from 2.83 to 5.3 years.
There were no significant differences between laparoscopic and open mesh repair groups in terms of the rate of hernia recurrence (five treatment arms) and development of chronic pain during more than one year after surgery (three trials).
Compared with open mesh repair, laparoscopic was associated with a significant reduction in pain on the Visual Analogue Scale (WMD −0.58, 95% −0.84 to −0.31; two trials), superficial wound infections (OR 0.29, 95% CI 0.08 to 0.96; five treatment arms) and time to return to daily activities (WMD −0.82 days, 95% CI −1.27 to −0.36; five treatment arms). However, laparoscopic procedure was associated with a significant increase in operation time (WMD 0.68 minutes, 95% CI 0.23 to 1.13; five treatment arms) compared with open mesh repair. There was no significant difference in the rate of seroma or haematoma formation or the need for additional operations between the two groups.
Significant heterogeneity was observed in the outcomes of operation time (I2=80%), return to daily activity (I2=80%) and seroma or haematoma formation (I2=78%).
No evidence of publication bias was found in most outcomes.