Department of Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ayten Sok. No: 13/4, Tandogan, Ankara, Turkey.
Hernia. 2013 Apr;17(2):167-75. doi: 10.1007/s10029-012-1018-y. Epub 2012 Nov 11.
PURPOSE: Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7 × 15 cm mesh that can be trimmed up to 2 cm from the lateral side. We performed a systematic review to determine surgeons' mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence. METHODS: Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word "Lichtenstein repair." All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90 cm(2) was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done. RESULTS: In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95 % of papers. Only 41 (11.2 %) papers discussed mesh size. In 29 studies, a mesh larger than 90 cm(2) was used. The most frequently preferred commercial mesh size was 7.5 × 15 cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95 % confidence interval: 0.007-0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1 year (p < 0.001). Heavy meshes also decreased recurrence (p = 0.015). CONCLUSION: This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely discussed in clinical studies. Papers that discuss mesh size appear to reflect a trend to comply with the latest recommendations to use larger mesh. Standard heavy meshes decrease the recurrence in hernia repair. Even though there is no evidence, it seems that large meshes decrease recurrence rates.
目的：由于覆盖不足或网片收缩，小网孔尺寸已被认为是导致 Lichtenstein 疝修补术后复发的因素之一。Lichtenstein 疝研究所建议使用 7×15cm 的网片，可从侧面修剪 2cm。我们进行了系统评价，以确定外科医生对 Lichtenstein 疝修补术的网片尺寸偏好，并进行荟萃分析以确定网片尺寸、网片类型和随访时间对复发的影响。
方法：使用关键词“Lichtenstein 修复”在两个医学数据库 PubMed 和 ISI Web of Science 中进行系统检索。选择所有全文论文。将提到网片尺寸的出版物纳入进一步分析。接受网片表面积为 90cm²作为定义小或大网片的阈值。此外，还根据网片尺寸、网片类型和随访时间进行了复发的亚组分析。
结果：共获得 514 篇论文。没有前瞻性或回顾性临床研究比较网片尺寸和临床结果。两个数据库中有 141 篇论文重复。因此，获得了 373 篇论文。超过 95%的论文可获得全文。只有 41 篇（11.2%）论文讨论了网片尺寸。在 29 项研究中，使用了大于 90cm²的网片。最常使用的商业网片尺寸为 7.5×15cm。没有论文提到修剪后的网片尺寸。没有关于网片尺寸与患者 BMI 之间关系的信息。小网片的复发 pooled proportion 为 0.0019（95%置信区间：0.007-0.0036），表明大网片可降低复发的机会。随访时间超过 1 年时，复发更为明显（p<0.001）。重网片也降低了复发（p=0.015）。
结论：本系统评价表明，在 Lichtenstein 疝修补术中使用的网片尺寸很少在临床研究中讨论。讨论网片尺寸的论文似乎反映了一种遵守使用大网片的最新建议的趋势。标准重网片可降低疝修补术后的复发率。尽管没有证据，但大网片似乎可以降低复发率。
Cochrane Database Syst Rev. 2017-2-7
Cochrane Database Syst Rev. 2018-9-13
Health Technol Assess. 2005-4
Cochrane Database Syst Rev. 2003
Cochrane Database Syst Rev. 2023-11-27
Cochrane Database Syst Rev. 2012-7-11
Cochrane Database Syst Rev. 2002
Health Technol Assess. 2001
Cochrane Database Syst Rev. 2021-4-19
Innov Surg Sci. 2017-4-13
Hernia. 2018-12-5
Surg Laparosc Endosc Percutan Tech. 2010-8
Ann R Coll Surg Engl. 2010-5
J Ayub Med Coll Abbottabad. 2009
Langenbecks Arch Surg. 2009-7-31
Zotero 插件