Comparing long-term clinical outcomes between laparoscopic versus open surgery for incisional hernia: a systematic review and meta-analysis of observational studies

Incisional hernia recurrence remains a significant surgical challenge, with ongoing debate regarding the optimal approach for repair. Laparoscopic Repair (LR) and Open Repair (OR) are two widely used techniques, each with distinct advantages and risks. This updated meta-analysis aims to evaluate real-world long-term clinical outcomes associated with Laparoscopic and open repair for Incisional hernia. A comprehensive and systematic literature search was conducted across PubMed, Embase, CINAHL Ultimate, Scopus, and Cochrane Library. Studies published between July 2013, and September 2025 were screened for inclusion. This review was designed to synthesize real-world, long-term outcomes; therefore, only observational studies were included, and randomized controlled trials were excluded by design. The data extracted included recurrence rates, surgical complications, and perioperative outcomes. A total of 28 observational studies, encompassing 56,056 patients from 13 countries, met the eligibility criteria, showing no significant difference between laparoscopic and open repair (RR = 0.89, 95% CI 0.79–1.0, p = 0.05; I² = 11.8%), although the pooled estimate numerically favored laparoscopic repair. In nine cohorts, laparoscopic repair was associated with a significantly lower risk of reoperation (RR = 0.62, 95% CI 0.42–0.91, p = 0.02; I² = 66.9%). Fourteen cohorts demonstrated a substantially lower risk of surgical-site infection with laparoscopy (RR = 0.28, 95% CI 0.23–0.34, p < 0.001; I² = 0%). Conversely, in eight cohorts, bowel injury was nearly twice as common after laparoscopy (RR = 1.96, 95% CI 1.04–3.73, p = 0.04; I² = 16.1%). No significant differences were observed in seroma (RR = 0.89, 95% CI 0.61–1.30, p = 0.56; I² = 74.6%) or hematoma (RR = 0.63, 95% CI 0.38–1.05, p = 0.08; I² = 0%). In observational clinical practice, laparoscopic and open incisional hernia repairs demonstrate comparable long-term recurrence rates. Laparoscopic repair offers advantages in reducing surgical-site infections and reoperations but is associated with a higher risk of bowel injury. Given the observational nature of available evidence, residual confounding and treatment-selection bias should be considered when interpreting these findings. Surgical approach selection should therefore remain individualized based on patient characteristics, hernia complexity, and surgical expertise.