ArticleHernia : the journal of hernias and abdominal wall surgery2026
Operative time and recurrence across five techniques of inguinal hernia repair: a Bayesian network meta-analysis of 29 randomized trials.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo benchmark the clinical efficiency and safety of five inguinal hernia repair techniques-open surgery, conventional laparoscopy (TAPP and TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted TAPP (r-TAPP)-to guide evidence-based surgical decision-making.
methodsFollowing PRISMA-NMA guidelines, we conducted a Bayesian network meta-analysis (NMA) of 29 randomized controlled trials (8,995 patients). Primary endpoints were operative time and recurrence; secondary outcomes included total complications and chronic pain. The certainty of evidence was systematically evaluated using the GRADE-NMA framework.
resultsOpen repair and conventional laparoscopy remained the most time-efficient approaches. Compared with open repair, r-TAPP was associated with longer operative time (MD 23.84 min; 95% CrI 2.74-44.29), and TAPP showed a moderate time penalty (MD 14.42 min; 95% CrI 1.02-28.04). For hernia recurrence, the current network remained statistically underpowered to detect clinically meaningful differences among the five modalities; all recurrence estimates were imprecise, particularly for the sparse r-TAPP (OR 1.44; 95% CrI 0.03-83.86) and SILS nodes. Minimally invasive approaches showed a numerically favorable trend toward less chronic pain relative to open repair, although certainty for this subjective outcome remained limited.
conclusionsTEP provides the most favorable time-efficiency profile among minimally invasive options, while TAPP offers comparable safety with a moderate time penalty. However, we remain very uncertain about the effects of r-TAPP and SILS on recurrence and overall safety because of sparse-event data and very low-certainty evidence. The currently observed temporal penalty of r-TAPP in most general centers likely reflects early technology adoption and learning-curve effects rather than the ultimate ceiling of robotic efficiency.
trial registrationPROSPERO (CRD420261306112).
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