Minimally Invasive Versus Open Parastomal Hernia Repair: A Comprehensive Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Parastomal hernia is a frequent and complex complication following stoma creation, often requiring surgical intervention. The optimal repair technique remains a subject of debate, with open and minimally invasive approaches each presenting distinct advantages and limitations. This meta-analysis systematically compares these techniques for parastomal hernia repair, evaluating key clinical outcomes including short- and long-term results.<h4>Methods</h4>We performed a comprehensive systematic review and meta-analysis following PRISMA guidelines, searching the PubMed, Web of Science, Scopus, and Cochrane Library databases through October 2024. Studies were included if they involved adult patients undergoing parastomal hernia repair using open and minimally invasive techniques, and reported at least two relevant clinical outcomes. Data were analyzed using Review Manager 5.4. Risk ratios (RRs) and mean differences (MDs) were calculated, with heterogeneity assessed through p-values. A random-effects model was applied for analyses with substantial heterogeneity.<h4>Results</h4>Minimally invasive approaches were associated with favorable outcomes compared to open surgery in several key parameters. Laparoscopic repair significantly reduced hospital stay by an average of 4 days compared to open techniques (p < 0.00001) and showed significantly lower complication rates, including surgical site infections (RR: 0.37- 0.63, p-values 0.02-0.03). Mortality was also significantly reduced in the laparoscopic group (RR: 0.18; p = 0.0009) while recurrence rates showed no significant difference between approaches. Robotic-assisted repair demonstrated a potential reduction in operative time (RR = 0.60, p = 0.007); however, this finding is based on a limited sample and should be interpreted with caution.<h4>Conclusion</h4>Laparoscopic repair of parastomal hernias provides significant advantages over open surgery including reduced morbidity, shorter hospital stays, and fewer complications. Although limited by sample size, robotic-assisted repair seems promising in reducing operative time and may offer added value in complex or recurrent cases; however, further research is needed to validate its cost-effectiveness and long-term outcomes. These findings support the preferential use of a minimally invasive approach in parastomal hernia repair whenever feasible while acknowledging that an individualized approach may still be necessary based on patient-specific factors and institutional resources.