Thirty-four RCTs (n=7,223) were included in the review.
Operating time.
Endoscopic techniques (TAPP and TEP) took a statistically significantly longer time than the Lichtenstein repair (65.7 minutes versus 55.5 minutes, P=0.01) and non-Lichtenstein open mesh techniques (58.6 minutes versus 41.5 minutes, P<0.00001). Statistically significant heterogeneity was found for both meta-analyses (P=0.02 and P=0.0002, respectively).
Total morbidity.
There was no statistically significant difference in total morbidity between endoscopic techniques and the Lichtenstein repair (OR 1.00, 95% CI: 0.87, 1.14). However, this result was strongly influenced by one large trial; when this trial was excluded, there was a statistically significantly higher total morbidity found for the Lichtenstein repair. Total morbidity was statistically significantly lower after endoscopic repair compared with non-Lichtenstein open mesh techniques (OR 0.73, 95% CI: 0.61, 0.89).
Potentially serious intra-operative complications.
There was no statistically significant difference in intra-operative bowel lesions or major vascular lesions between endoscopic repairs and open mesh repairs (OR 2.01, 95% CI: 0.40, 9.99 and 7.37, 95% CI: 0.77, 70.89, respectively). There was a statistically significantly higher incidence of urinary bladder lesions with endoscopic repairs than open mesh repairs (OR 7.31, 95% CI: 1.03, 51.95).
Wound infection.
There was a statistically significantly lower incidence of wound infection after endoscopic techniques than after Lichtenstein repair (OR 0.39, 95% CI: 0.26, 0.61) and after non-Lichtenstein open mesh techniques (OR 0.50, 95% CI: 0.27, 0.94).
Haematoma.
There was a statistically significantly lower incidence of inguinal haematomas after endoscopic techniques than after Lichtenstein repair (OR 0.69, 95% CI: 0.54, 0.90) and after non-Lichtenstein open mesh techniques (OR 0.55, 95% CI: 0.42, 0.71).
Seroma.
There was a statistically significantly higher incidence of seroma after endoscopic techniques than after Lichtenstein repair (OR 1.42, 95% CI: 1.13, 1.79). However, there was no statistically significant difference in the incidence of seroma after endoscopic repair and non-Lichtenstein open mesh techniques (OR 0.84, 95% CI: 0.57, 1.24).
Urinary retention.
There was no statistically significant difference in post-operative urinary retention rates between endoscopic repairs and Lichtenstein repair (OR 1.32, 95% CI: 0.89, 1.94) or endoscopic repairs and non-Lichtenstein open mesh techniques (OR 1.96, 95% CI: 0.96, 3.99).
Time to return to work.
The mean time to return to work or normal activities was statistically significantly shorter after endoscopic techniques than after Lichtenstein repair (14.8 versus 21.4 days, P<0.00001) or after non-Lichtenstein open mesh techniques (13.8 versus 22.2 days, P<0.00001).
Inguinal paresthesia.
There was a statistically significantly lower incidence of inguinal or scrotal paresthesia after endoscopic techniques than after Lichtenstein repair (OR 0.46, 95% CI: 0.35, 0.61) or after non-Lichtenstein open mesh techniques (OR 0.35, 95% CI: 0.26, 0.47). Statistically significant heterogeneity was found for the first of these meta-analyses (P<0.00001).
Long-term chronic pain.
There was a statistically significantly lower incidence of long-term inguinal or scrotal chronic pain syndromes after endoscopic techniques than after Lichtenstein repair (OR 0.56, 95% CI: 0.44, 0.70). However, there was no statistically significant difference between endoscopic techniques and non-Lichtenstein open mesh techniques (OR 0.87, 95% CI: 0.50, 1.52).
Testicular problems.
There was no statistically significant difference in post-operative testicular problems between endoscopic techniques and open mesh repair (OR 0.71, 95% CI: 0.39, 1.28).
Hernia recurrence.
There was a statistically significantly higher incidence of hernia recurrence after endoscopic techniques than after Lichtenstein repair (OR 2.00, 95% CI: 1.46, 2.74). However, this result was strongly influenced by one large trial; when this trial was excluded, there was no statistically significant difference in the recurrence rate. There was no statistically significant difference in the hernia recurrence rate between endoscopic techniques and non-Lichtenstein open mesh techniques (OR 1.18, 95% CI: 0.69, 2.04).