La Regina Davide, Gaffuri Paolo, Ceppi Marcello, Saporito Andrea, Ferrari Matteo, Di Giuseppe Matteo, Mongelli Francesco
Department of Surgery, San Giovanni Hospital, Bellinzona, Switzerland.
Department of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy.
J Minim Access Surg. 2019 Oct-Dec;15(4):281-286. doi: 10.4103/jmas.JMAS_218_18.
Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature.
A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were ('laparoscopic' OR 'laparoscopy') AND ('inguinal' OR 'groin' OR 'hernia') AND 'prostatectomy'.
The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85-4.97), conversion to open surgery (RR 3.91; 95% CI 0.85-18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39-4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05-18.64), due to an injury of the inferior epigastric vessels.
Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP.
根治性前列腺切除术（RP）是原发性腹股沟疝（IH）发生的一个重要后天危险因素，估计术后2年内发病率为15.9%。前列腺切除相关的腹膜前纤维化反应会使腹腔镜下腹股沟疝修补术在技术上变得困难，即便其安全性和可行性尚未得到广泛评估。我们对现有文献进行了系统综述。
按照系统评价和Meta分析的首选报告项目指南，对PubMed和MEDLINE数据库进行了全面的计算机文献检索。检索词为（“腹腔镜”或“腹腔镜检查”）与（“腹股沟”或“腹股沟区”或“疝”）以及“前列腺切除术”。
从PubMed和MEDLINE数据库检索到156篇文章。5篇文章被认为符合分析条件，包括229例接受277次疝修补术的患者。汇总分析表明，前列腺切除术后组与对照组在术后并发症（风险比[RR]2.06；95%置信区间[CI]0.85 - 4.97）、转为开放手术（RR 3.91；95% CI 0.85 - 18.04）和疝复发（RR 1.39；95% CI 0.39 - 4.93）方面无统计学显著差异。由于腹壁下血管损伤，在轻微术中并发症方面存在统计学显著差异（RR 4.42；CI 1.05 - 18.64）。
我们的系统综述表明，在经验丰富的医生手中，先前接受过前列腺切除术的患者进行微创腹股沟疝修补术的安全性、可行性和临床结果与未接受过RP的患者相当。
