DeAsis Francis J, Lapin Brittany, Gitelis Matthew E, Ujiki Michael B
Francis J DeAsis, Brittany Lapin, Matthew E Gitelis, Michael B Ujiki, Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL 60201, United States.
World J Gastroenterol. 2015 Jul 28;21(28):8670-7. doi: 10.3748/wjg.v21.i28.8670.
To evaluate the efficacy and safety of the laparoscopic approaches for parastomal hernia repair reported in the literature.
A systematic review of PubMed and MEDLINE databases was conducted using various combination of the following keywords: stoma repair, laparoscopic, parastomal, and hernia. Case reports, studies with less than 5 patients, and articles not written in English were excluded. Eligible studies were further scrutinized with the 2011 levels of evidence from the Oxford Centre for Evidence-Based Medicine. Two authors reviewed and analyzed each study. If there was any discrepancy between scores, the study in question was referred to another author. A meta -analysis was performed using both random and fixed-effect models. Publication bias was evaluated using Begg's funnel plot and Egger's regression test. The primary outcome analyzed was recurrence of parastomal hernia. Secondary outcomes were mesh infection, surgical site infection, obstruction requiring reoperation, death, and other complications. Studies were grouped by operative technique where indicated. Except for recurrence, most postoperative morbidities were reported for the overall cohort and not by approach so they were analyzed across approach.
Fifteen articles with a total of 469 patients were deemed eligible for review. Most postoperative morbidities were reported for the overall cohort, and not by approach. The overall postoperative morbidity rate was 1.8% (95%CI: 0.8-3.2), and there was no difference between techniques. The most common postoperative complication was surgical site infection, which was seen in 3.8% (95%CI: 2.3-5.7). Infected mesh was observed in 1.7% (95%CI: 0.7-3.1), and obstruction requiring reoperation also occurred in 1.7% (95%CI: 0.7-3.0). Other complications such as ileus, pneumonia, or urinary tract infection were noted in 16.6% (95%CI: 11.9-22.1). Eighty-one recurrences were reported overall for a recurrence rate of 17.4% (95%CI: 9.5-26.9). The recurrence rate was 10.2% (95%CI: 3.9-19.0) for the modified laparoscopic Sugarbaker approach, whereas the recurrence rate was 27.9% (95%CI: 12.3-46.9) for the keyhole approach. There were no intraoperative mortalities reported and six mortalities during the postoperative course.
Laparoscopic intraperitoneal mesh repair is safe and effective for treating parastomal hernia. A modified Sugarbaker approach appears to provide the best outcomes.
评估文献报道的腹腔镜修补造口旁疝的疗效和安全性。
使用以下关键词的各种组合对PubMed和MEDLINE数据库进行系统综述：造口修复、腹腔镜、造口旁、疝。排除病例报告、患者少于5例的研究以及非英文撰写的文章。符合条件的研究进一步根据牛津循证医学中心2011年的证据水平进行审查。两位作者对每项研究进行审查和分析。如果评分存在差异，则将有争议的研究提交给另一位作者。使用随机效应模型和固定效应模型进行荟萃分析。使用Begg漏斗图和Egger回归检验评估发表偏倚。分析的主要结局是造口旁疝复发。次要结局包括补片感染、手术部位感染、需要再次手术的梗阻、死亡和其他并发症。如有指示，研究按手术技术分组。除复发外，大多数术后发病率是针对整个队列报告的，而非按手术方式报告，因此对所有手术方式进行综合分析。
15篇文章共469例患者被认为符合审查条件。大多数术后发病率是针对整个队列报告的，而非按手术方式报告。总体术后发病率为1.8%（95%CI：0.8 - 3.2），不同技术之间无差异。最常见的术后并发症是手术部位感染，发生率为3.8%（95%CI：2.3 - 5.7）。观察到补片感染的发生率为1.7%（95%CI：0.7 - 3.1），需要再次手术的梗阻发生率也为1.7%（95%CI：0.7 - 3.0）。其他并发症如肠梗阻、肺炎或尿路感染的发生率为16.6%（95%CI：11.9 - 22.1）。总体报告81例复发，复发率为17.4%（95%CI：9.5 - 26.9）。改良腹腔镜Sugarbaker手术方式的复发率为10.2%（95%CI：3.9 - 19.0），而钥匙孔手术方式的复发率为27.9%（95%CI：12.3 - 46.9）。未报告术中死亡病例，术后病程中有6例死亡。
腹腔镜腹腔内补片修补术治疗造口旁疝安全有效。改良Sugarbaker手术方式似乎能提供最佳疗效。
