Outcomes of surgical repair of acquired lateral abdominal wall hernias: a meta-analysis.

Abstract

<h4>Purpose</h4>Acquired lateral abdominal wall hernias (LAWH) are rare, anatomically complex defects that pose a surgical challenge. This study aims to evaluate outcomes and compare surgical approaches for acquired LAWH repair.<h4>Methods</h4>A systematic search of PubMed and EMBASE was conducted in June 2024. Studies describing single surgical techniques or comparative approaches for acquired LAWHs were included. The primary outcome was recurrence; secondary outcomes included postoperative complications. Meta-analysis estimated pooled rates; pairwise analysis compared laparoscopic and open approaches.<h4>Results</h4>Data from 41 studies comprising 10,771 participants were pooled. The median age was 59.9 years (36.4-70.0), BMI was 29 kg/m² (20.95-33), and 47.2% were male. The median defect size was 8.28 cm (2.18-100); area was 78.6 cm² (6.4-232). Median follow-up was 29.9 months (3.6-170). The pooled recurrence rate was 5.4%. Recurrence rates were 3.8% for flank, 2.7% for lumbar, 3.5% for incisional, and 1.6% for primary hernias. Recurrence differed by surgical approach, with rates of 4.5% for laparoscopic and 5.9% for open repair, and by mesh placement, with rates of 4.1% for extraperitoneal and 5.2% for intraperitoneal placement. The overall complication rate was 15.8%, including SSOs (9.9%) and SSIs (2.7%). Specific postoperative complications included hematoma (1.4%), seroma (5.8%), and wound infection (2.3%). Pairwise analysis of three studies showed a significant reduction in recurrence with the laparoscopic approach (OR = 0.66 [0.53-0.83], p = 0.0003, I² = 0%) but no significant difference in overall complication rates (OR = 0.82 [0.49-1.36], p = 0.44, I² = 65%).<h4>Conclusion</h4>This meta-analysis presents the first pooled estimates of recurrence and complication rates for acquired LAWHs, highlighting variations based on hernia characteristics and management. Laparoscopic repair was associated with a 33.6% lower recurrence rate, with similar overall complication rates. Further research is needed to optimize surgical approaches and outcomes.