Abstract Aims Inguinal hernia repair is a common surgical procedure worldwide. The development of Minimally Invasive Surgery (MIS), including laparoscopic and robotic-assisted techniques, has represented a quantum leap to further improve patient outcomes through minimizing postoperative pain and hastening recovery. This study evaluates the efficacy, safety, and novel evolutions in MIS approaches compared to traditional open surgery. Methods We conducted a systematic review and meta-analyses of 22 peer-reviewed studies, including randomized controlled trials and cohort studies with at least 20 patients per arm and follow-up of six months or more. Primary outcomes were postoperative pain and recurrence rates, while secondary outcomes included operative time, hospital stay, complications, and patient satisfaction. Data synthesis followed PRISMA guidelines with a random-effects model. Results MIS techniques, such as Transabdominal Preperitoneal (TAPP) and Total Extraperitoneal (TEP) repairs, demonstrated shorter hospital stays (Mean Difference = -0.6 days) and less postoperative pain (Mean Difference = -1.6) compared to open surgery. Robotic-assisted surgery allows for finer dissection with precise mesh placement, thus potentially reducing recurrence rates (2.1% vs. 3.8%; RR = 0.56), although it is more expensive. Complication rates were similar across MIS methods but lower at high volume centers. Patient satisfaction were consistently higher with MIS. Conclusions MIS shows promising results mainly in reducing recovery time and postoperative pain. However, regarding general acceptance, robotic-assisted techniques have to be weighed against associated costs and resource use. Future studies should aim at refining surgical training and improving MIS technologies access in low-resource settings to ensure equity in surgical care.
Lim et al. (Fri,) studied this question.