Endoscopic component separation for ventral hernia causes fewer wound complications compared to open components separation: a systematic review and meta-analysis.

BACKGROUND: Open component separation (OCS) for tension-free approximation of fascial borders is increasingly used for repair of large midline ventral hernias. Recent studies suggested lower complication rates following a modified version of this technique with an endoscopic approach (ECS). The aim of this meta-analysis was to compare the outcomes after ECS and OCS.

METHODS: A literature search was performed in PubMed and Embase in order to identify studies comparing ECS and OCS as a supplementary procedure for surgical repair of ventral hernia. The included studies were independently assessed using the Newcastle Ottawa Scale. Outcomes analyzed were wound complications, hernia recurrence and length of stay. A meta-analysis on the pooled data was performed.

RESULTS: The literature search identified 222 articles, of which five retrospective comparative cohort studies were included in the review and meta-analysis reporting on a total of 163 patients. Patient demography and the rates of mesh repair were comparable between the ECS and OCS patient groups. The incidence of wound complications comprising surgical site infection, skin necrosis, subcutaneous abscess, seroma, skin dehiscence, cellulitis, and fistula was significantly less after ECS (odds ratio [OR] 0.27, 95 % confidence interval [CI] 0.12-0.58, p < 0.001). The incidence of recurrent hernia was 13 % after ECS and 16 % after OCS (OR 0.76, 95 % CI 0.29-1.98, p = 0.57). Four studies reported length of stay that was comparable between the groups (mean difference -0.14 days, 95 % CI -1.49 to 1.21, p = 0.84).

CONCLUSIONS: ECS causes fewer wound complications compared with OCS.