JAMA Surg. 2014 May;149(5):415-21. doi: 10.1001/jamasurg.2013.5014.
More than 350,000 ventral hernias are repaired in the United States annually, of which 75% are primary ventral hernias (eg, umbilical or epigastric hernias). Despite the volume, there is insufficient evidence to support the use of sutures vs mesh for primary ventral hernia repairs.
To compare suture vs mesh repairs for 3 outcomes: hernia recurrence, surgical site infection (SSI), and seromas.
Randomized controlled trials, case-control, and cohort studies were identified from OVID, PubMed, and reference lists from January 1, 1980, through June 1, 2012.
English-language studies with adult patients were eligible for review if there was mention of both suture and mesh techniques used during elective repair of a primary ventral hernia. Two study authors independently reviewed the 1492 articles originally identified and selected 9 for analysis. The Downs and Black 26-item checklist was used to critically assess the risk of bias.
Year of publication, study design, inclusion and exclusion criteria, number of patients, follow-up duration, use of preoperative antibiotics, size of hernias repaired, age, body mass index (calculated as weight in kilograms divided by height in meters squared), American Society of Anesthesiologists grade, repair techniques, incidence of hernia recurrence, seroma, and SSI.
Three separate univariate meta-analyses for each end point followed by a multivariate meta-analysis were performed. Across all 9 studies, there were 637 mesh repairs and 1145 suture repairs. The pooled mesh repairs demonstrated a 2.7% recurrence rate, 7.7% seroma rate, and 7.3% SSI rate The pooled suture repairs demonstrated an 8.2% recurrence rate, 3.8% seroma rate, and 6.6% SSI rate. On the basis of results from the multivariate meta-analysis, recurrences (log odds ratio , −1.04; 95% CI, −1.58 to −0.52) were more common with suture repair, whereas seromas (0.84; 0.27-1.41) and SSIs (0.65; 0.12-1.18) were more common with mesh repair.
Mesh repair has a small reduction in recurrence rates compared with suture repairs for primary ventral hernias, but an increased risk of seroma and SSI was observed. Further high-quality studies are necessary to determine whether suture or mesh repair leads to improved outcomes for primary ventral hernias.
美国每年有超过 35 万例腹侧疝需要修复，其中 75%为原发性腹侧疝（例如脐疝或上腹疝）。尽管数量众多，但仍缺乏足够的证据支持使用缝线与网片来修复原发性腹侧疝。
比较缝线与网片修复术在 3 个结果方面的差异：疝复发、手术部位感染（SSI）和血清肿。
从 OVID、PubMed 和参考文献中，检索了 1980 年 1 月 1 日至 2012 年 6 月 1 日期间的随机对照试验、病例对照和队列研究。
如果有文献提及用于择期修复原发性腹侧疝的缝线和网片技术，则纳入接受审查的为英文文献且纳入成年患者的研究。两位研究作者独立地对最初确定的 1492 篇文章进行了回顾，并选择了 9 篇进行分析。使用 Downs 和 Black 26 项清单来对偏倚风险进行严格评估。
出版年份、研究设计、纳入和排除标准、患者数量、随访时间、术前使用抗生素、修复的疝大小、年龄、体重指数（体重以千克为单位，除以身高的平方米）、美国麻醉师协会分级、修复技术、疝复发、血清肿和 SSI 的发生率。
对每个终点分别进行 3 项单变量荟萃分析，然后进行多变量荟萃分析。在所有 9 项研究中，有 637 例网片修复和 1145 例缝线修复。汇总的网片修复结果显示，复发率为 2.7%，血清肿发生率为 7.7%，手术部位感染发生率为 7.3%。汇总的缝线修复结果显示，复发率为 8.2%，血清肿发生率为 3.8%，手术部位感染发生率为 6.6%。基于多变量荟萃分析的结果，缝线修复的复发风险更高（对数优势比，-1.04；95%置信区间，-1.58 至 -0.52），而网片修复的血清肿（0.84；0.27-1.41）和手术部位感染（0.65；0.12-1.18）风险更高。
网片修复与缝线修复相比，原发性腹侧疝的复发率略有降低，但观察到血清肿和手术部位感染的风险增加。需要进一步进行高质量的研究，以确定缝线或网片修复是否能为原发性腹侧疝带来更好的结局。
