Comparison of outcomes of minimally invasive vs. open surgery in patients with symptomatic hiatal hernias: a systematic review and meta-analysis.

OBJECTIVE

To conduct a systematic review and meta-analysis of studies that compared minimally invasive surgery (MIS) to open surgery on postoperative outcomes in patients with symptomatic hiatal hernia (HH).

BACKGROUND

Early literature raised questions about whether MIS was associated with higher HH recurrence rates compared to open surgery. Previous systematic reviews comparing the two approaches did not formally address recurrence as an outcome.

METHODS

Searches were conducted in MEDLINE, EMBASE, and reference lists up to June 13th, 2024. English-language studies comparing MIS (laparoscopy and robotic-assisted) to open surgery (laparotomy and thoracotomy) in symptomatic HH patients were eligible. A generic inverse variance using fixed-effects meta-analysis was performed. Evidence quality was assessed using GRADE.

RESULTS

The analysis included 21 studies (n = 184,381). No randomized controlled trials were identified. MIS was not associated with increased risk of hiatal hernia recurrence (RR = 0.87 [95% CI: 0.57, 1.33]; p = 0.52; GRADE: very low) and was associated with lower 30-day mortality (RR = 0.21 [0.15, 0.29]; p < 0.0001; GRADE: low), wound infection (RR = 0.24 [0.18, 0.32]; p < 0.00001; GRADE: very low), and shorter hospital stay (MD = -4.44 [- 4.69, - 4.20]; p < 0.00001; GRADE: low).

CONCLUSIONS AND RELEVANCE: MIS compared to open surgery was not associated with an increased risk of HH recurrence and was associated with a lower risk of 30-day mortality, wound infection, and shorter hospital stays. Evidence quality ranged from low to very low. Higher quality studies are needed to confirm the current findings.

PROSPERO REGISTRATION: CRD42020164419.