Inguinal Hernia: Modern Surgical Treatment Methods (Systematic Review and Meta-Analysis)

Aman Berkinbay 1 2 * , Abylai Baymakhanov 1 3, Onlassyn Ibekenov 1 4, Aydar Raimkhanov 1 3, Dias Myrzash 1, Nurjan Tapalov 1, Salamat Zhangabayev 1, Zhangeldy Kashkarbayev 1, Mereke Uais 1, Aray Mukametkhan 1, Temirlan Atey 1, Abylay Akhmetkali 1
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1 JSC «Asfendiyarov Kazakh National Medical University», Almaty, the Republic of Kazakhstan
2 City Emergency Medical Care Hospital, Almaty, the Republic of Kazakhstan;
3 City Clinical Hospital №4 of Almaty, Almaty, the Republic of Kazakhstan;
4 JSC "National Scientific Center of Surgery named after Syzganov", Almaty, Republic of Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 23, Issue 1, pp. 79-92. https://doi.org/10.23950/jcmk/17745
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Author Contributions: Conceptualization, A. B., Ab. B., O. I., A. R.; investigation, A. B., D. M., N. T., S. Zh., Zh. K.; data curation, A. B., Ab. B., O. I.,  A. R.; writing – original draft preparation, A. B.; writing – review and editing, A. B., Ab. B., O. I.,  A. R., D. M., N. T., S. Zh.,  Zh. K., M. U., A. M., T. A., A. A. All authors have read and agreed to the published version of the manuscript.

Data availability statement: The corresponding author can provide the data supporting the study's conclusions upon request. 

Artificial Intelligence (AI) Disclosure Statement: AI-Unassisted Work.

ABSTRACT

Background: Inguinal hernia (IH) is among the most common conditions in general surgery, accounting for up to 75–80% of anterior abdominal wall hernias. Open Lichtenstein repair remains widely used but is associated with postoperative pain and longer recovery. The increasing adoption of laparoscopic (TAPP, TEP) and robotic (R-TAPP, R-TEP) techniques aims to improve perioperative and functional outcomes.
Objective: To perform a systematic review and meta-analysis comparing open, laparoscopic, and robotic inguinal hernia repair with respect to operative parameters, postoperative outcomes, and recurrence.
Methods: This study was conducted according to PRISMA 2020 and AMSTAR 2 guidelines. PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched for studies published between January 2015 and August 2025. Outcomes included operative time, recurrence, postoperative complications, hospital stay, and readmission. Pooled estimates were calculated as odds ratios (OR) or standardized mean differences (SMD) with 95% confidence intervals (CI).
Results: Twenty-one comparative studies comprising 66,274 patients were included: 2,188 (3.3%) open, 55,145 (83.2%) laparoscopic, and 8,941 (13.5%) robotic repairs. Operative time was longest for robotic repair, exceeding open and laparoscopic approaches by approximately 40% and 20%, respectively. Minimally invasive techniques significantly reduced postoperative complications (open 7.3–7.8%, laparoscopic 5.6%, robotic 4.1%) and shortened hospital stay (open 2.1 days, laparoscopic 1.4 days, robotic 1.1 days). Recurrence rates were low across all techniques (open 2.4%, laparoscopic 1.4%, robotic 1.2%). Pooled analysis demonstrated higher odds of recurrence for robotic versus open repair (OR = 3.41; 95% CI 1.47–7.89), while robotic and laparoscopic approaches showed equivalent recurrence risk (OR = 1.04; p = 0.86). Readmission rates remained low (<2%) and comparable between minimally invasive techniques.
Conclusion: Laparoscopic and robotic inguinal hernia repair provide superior perioperative outcomes compared with open surgery. Robotic repair offers the lowest complication rates and shortest hospitalization, though slightly longer operative time and higher pooled odds of recurrence versus open repair warrant cautious interpretation and further long-term studies.
Keywords: inguinal hernia, Lichtenstein method, TAPP (Transabdominal Preperitoneal Repair), TEP (Totally Extraperitoneal Repair), R-TAPP (Robotic Transabdominal Preperitoneal Repair), R-TEP (Robotic Totally Extraperitoneal Repair), complications, recurrence, meta-analysis.

CITATION

Berkinbay A, Baymakhanov A, Ibekenov O, Raimkhanov A, Myrzash D, Tapalov N, et al. Inguinal Hernia: Modern Surgical Treatment Methods (Systematic Review and Meta-Analysis). J CLIN MED KAZ. 2026;23(1):79-92. https://doi.org/10.23950/jcmk/17745

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