Hodgkinson J D, Leo C A, Maeda Y, Bassett P, Oke S M, Vaizey C J, Warusavitarne J
St Mark's Hospital and Academic Institute, Watford Road, Harrow, London, HA1 3UJ, UK.
Department of Surgery and Cancer, 10th Floor, QEQM Building, St Mary's Campus, Imperial College, Praed Street, Paddington, London, W2 1NY, UK.
Hernia. 2018 Aug;22(4):617-626. doi: 10.1007/s10029-018-1757-5. Epub 2018 Mar 7.
This study aims to compare the outcomes of posterior component separation and transversus abdominis release (PCSTAR) with the open anterior component separation (OACS) technique. OACS, first described by Ramirez et al. (Plast Reconstr Surg 86(3):519-526, 1990), has become an established technique for local myofascial advancement in abdominal hernia surgery. PCSTAR, described by Novitsky et al. (Am J Surg 204(5):709-716, 2012), is being used more frequently and is rapidly becoming the technique of choice in complex ventral hernia repair.
Analysis was conducted according to PRISMA guidelines. A systematic search of the MEDLINE, EMBASE and Pubmed databases was performed. Studies reporting exclusively on midline ventral hernia repair were reviewed. Studies describing PCSTAR were selected and compared to matched studies describing OACS. Meta-analysis was used to compare outcomes between the two-pooled groups.
Seven studies describing 281 cases of PCSTAR for midline incisional hernia using a retromuscular mesh placement were identified. Six comparable studies describing 285 cases of OACS and retromuscular mesh placement were identified from the same search. Pooled analysis demonstrated a hernia recurrence rate of 5.7% (3.0-8.5) for PCSTAR and 9.5% (4.0-14.9) for OACS. Comparative analysis demonstrated no significant difference between hernia recurrence rate (p = 0.23). The use of bridging mesh was not significantly reduced by the use of PCSTAR (3.1%) when compared to ACS (7.5%) (p = 0.22). No significant difference was found in wound complication rates between PCSTAR and OACS, respectively, 'superficial' 10.9 vs 21.6% (p = 0.15); and 'deep' 9.5 vs 12.7% (p = 0.53).
These data suggest PCSTAR have comparable outcomes to OACS. This analysis is limited by the lack of comparative studies and heterogenicity in the OACS group.
本研究旨在比较后入路成分分离联合腹横肌松解术（PCSTAR）与开放前路成分分离术（OACS）的手术效果。OACS由拉米雷斯等人首次描述（《整形与重建外科》86(3):519 - 526, 1990），已成为腹疝手术中局部肌筋膜推进的成熟技术。PCSTAR由诺维茨基等人描述（《美国外科杂志》204(5):709 - 716, 2012），使用频率越来越高，正迅速成为复杂腹疝修补的首选技术。
根据PRISMA指南进行分析。对MEDLINE、EMBASE和Pubmed数据库进行系统检索。回顾仅报道中线腹疝修补的研究。选择描述PCSTAR的研究，并与描述OACS的匹配研究进行比较。采用荟萃分析比较两组汇总后的结果。
确定了7项研究，共281例采用肌后补片置入的中线切口疝PCSTAR病例。通过相同检索确定了6项可比研究，共285例采用肌后补片置入的OACS病例。汇总分析显示，PCSTAR的疝复发率为5.7%（3.0 - 8.5），OACS为9.5%（4.0 - 14.9）。对比分析显示疝复发率无显著差异（p = 0.23）。与OACS（7.5%）相比，PCSTAR使用桥接补片的比例未显著降低（3.1%）（p = 0.22）。PCSTAR和OACS的伤口并发症发生率分别为“浅表”10.9%对21.6%（p = 0.15）；“深部”9.5%对12.7%（p = 0.53），无显著差异。
这些数据表明PCSTAR与OACS的手术效果相当。本分析因缺乏比较研究以及OACS组的异质性而受到限制。
