Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery

To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery.

We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed.

The total incidence in the 84 studies was 4.8% (95% CI 3.7% – 6.2%) I² 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%—11.8%) I² 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%—3.4%) I² 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%—4.8%) I² 76.96% and off-midline: 4.7% (95% CI 3.5%—6.4%) I² 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% – 23%) I² 77.39%.

Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access.

The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.