Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, Montreal, QC, E19-125, Canada.
Section of Colon and Rectal Surgery, McGill University Health Centre, Montreal, QC, Canada.
Surg Endosc. 2017 Dec;31(12):5083-5093. doi: 10.1007/s00464-017-5573-2. Epub 2017 Apr 25.
The incidence of incisional hernia(IH) may be affected by the choice of specimen extraction incision. The objective of this study was to perform a systematic review and meta-analysis comparing the incidence of IH after midline and off-midline incisions in patients undergoing laparoscopic colorectal surgery.
A systematic search was performed according to PRISMA guidelines to identify all comparative studies from January 1991-August 2016 on the incidence of IH after midline and off-midline(transverse or Pfannenstiel) incisions in patients undergoing laparoscopic colorectal surgery. Case series and studies reporting the IH after stoma site extraction, SILS, or NOTES were excluded. The MINORS instrument was used for quality assessment for observational studies. Weighted estimates were calculated using a random-effects model.
A total of 17 articles were identified and included for meta-analysis, 16 of which were observational studies and 1 was an RCT. The mean MINORS score for observational studies was 12.9 (SD 3.2, range 7-17). Sample sizes in the midline (mean 185, range 20-995) and off-midline(mean 184, range 20-903) groups were similar. Follow-up ranged from 17.3 to 42 months. The pooled incidence of IH was 10.6% (338/3177) in midline, 3.7% (48/1314) in transverse, and 0.9% (9/956) in Pfannenstiel incisions. IH was significantly higher in the midline compared to off-midline groups (weighted OR 4.1, 95% CI 2.0-8.3, I = 79.7%, p for heterogeneity <0.001). Midline incisions were also at higher risk of IH versus transverse (weighted OR 3.0, 95% CI 1.4-6.7, I = 72.7%, p for heterogeneity <0.001) and Pfannenstiel (weighted OR 8.6, 95% CI 3.0-24.6, I = 43.5%, p for heterogeneity = 0.101) incisions. There was no publication bias according the funnel plot or statistically (Egger's p = 0.336).
Midline incisions for specimen extraction in laparoscopic colorectal surgery are at significantly higher risk of IH compared to off-midline (transverse or Pfannenstiel) incisions, but these data are of poor quality and heterogeneous.
切口疝（IH）的发生率可能受到标本提取切口选择的影响。本研究的目的是进行系统评价和荟萃分析，比较腹腔镜结直肠手术中采用中线和非中线（横切口或Pfannenstiel 切口）切口的 IH 发生率。
根据 PRISMA 指南进行系统检索，以确定 1991 年 1 月至 2016 年 8 月期间所有比较腹腔镜结直肠手术中采用中线和非中线（横切口或 Pfannenstiel 切口）切口的 IH 发生率的病例对照研究。排除了经造口部位提取、SILS 或NOTES 报道 IH 的病例系列和研究。采用 MINORS 仪器对观察性研究进行质量评估。使用随机效应模型计算加权估计值。
共确定了 17 篇文章进行荟萃分析，其中 16 篇为观察性研究，1 篇为 RCT。观察性研究的 MINORS 平均得分为 12.9（SD 3.2，范围 7-17）。中线组（平均 185，范围 20-995）和非中线组（平均 184，范围 20-903）的样本量相似。随访时间从 17.3 个月到 42 个月。中线组 IH 的总发生率为 10.6%（338/3177），横切口组为 3.7%（48/1314），Pfannenstiel 切口组为 0.9%（9/956）。与非中线组相比，中线组 IH 发生率显著更高（加权 OR 4.1，95%CI 2.0-8.3，I²=79.7%，p<0.001）。与横切口（加权 OR 3.0，95%CI 1.4-6.7，I²=72.7%，p<0.001）和 Pfannenstiel 切口（加权 OR 8.6，95%CI 3.0-24.6，I²=43.5%，p=0.101）相比，中线切口发生 IH 的风险也更高。根据漏斗图或统计学（Egger's p=0.336）均未发现发表偏倚。
与非中线（横切口或 Pfannenstiel 切口）切口相比，腹腔镜结直肠手术中采用中线切口提取标本会显著增加 IH 的风险，但这些数据质量较差且存在异质性。
