1 Gastrounit, Surgical Division, Centre for Surgical Research (CSR), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
2 Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Scand J Surg. 2019 Sep;108(3):187-193. doi: 10.1177/1457496918812208. Epub 2018 Nov 29.
The use of mesh repair in a small- or middle-sized umbilical hernia remains controversial, and evidence is based on only few and small heterogeneous randomized trials. The primary aim was to assess differences, if any, in recurrence (clinical and reoperation), and secondary aim was to assess differences in infections, seroma formation, hematomas, chronic pain, cosmetic result, and quality of life.
A systematic review (predefined search strategy) and meta-analyses were conducted based on pre-study strict and well-defined methodology. The literature search was completed on 1 January 2018. The study protocol was registered in PROSPERO.
Five randomized controlled trials were identified (mesh repair, n = 326 versus non-mesh sutured repair, n = 330) and 602 records were excluded. Randomized controlled trials included patients with defect diameters of ⩾1 to 4 cm. Mesh repair reduced the risk of recurrence compared with sutured repair with a relative risk of 0.28 (95% confidence interval = 0.13-0.58, I = 0%, number needed to treat = 13 patients). Additional analyses found no differences between the two surgical techniques regarding infection (relative risk = 0.80, 95% confidence interval = 0.36-1.79), seroma formation (relative risk = 1.38, 95% confidence interval = 0.57-3.32), or hematomas (relative risk = 0.55, 95% confidence interval = 0.23-1.30). Lack of sufficient data precluded meta-analysis evaluating risk of seroma formation, hematomas, chronic pain, cosmetic result, and quality of life.
Mesh repair is recommended for umbilical hernia of ⩾1 to 4 cm. More evidence is needed for the optimal placement of the mesh (sublay or onlay) and the role of mesh in patients with an umbilical hernia <1 cm.
在小或中等脐疝中使用网片修补仍然存在争议，并且证据仅基于少数小型且异质性的随机试验。主要目的是评估复发（临床和再次手术）方面的差异，如果有差异的话，次要目的是评估感染、血清肿形成、血肿、慢性疼痛、美容效果和生活质量方面的差异。
根据预先设定的严格且明确的方法进行了系统评价（预先定义的搜索策略）和荟萃分析。文献检索于 2018 年 1 月 1 日完成。研究方案已在 PROSPERO 中注册。
确定了 5 项随机对照试验（网片修补组，n=326 例与非网片缝合修补组，n=330 例），排除了 602 份记录。随机对照试验纳入了缺损直径≥1 至 4 cm 的患者。与缝合修补相比，网片修补降低了复发风险，相对风险为 0.28（95%置信区间 0.13-0.58，I=0%，需要治疗的患者数=13 例）。进一步的分析发现，两种手术技术在感染（相对风险=0.80，95%置信区间 0.36-1.79）、血清肿形成（相对风险=1.38，95%置信区间 0.57-3.32）或血肿（相对风险=0.55，95%置信区间 0.23-1.30）方面无差异。由于缺乏足够的数据，无法进行荟萃分析评估血清肿形成、血肿、慢性疼痛、美容效果和生活质量的风险。
对于直径≥1 至 4 cm 的脐疝，推荐使用网片修补。对于直径<1 cm 的脐疝，需要更多证据来确定网片的最佳放置位置（下置或上置）以及网片的作用。
