Köckerling Ferdinand
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
Front Surg. 2018 Nov 27;5:71. doi: 10.3389/fsurg.2018.00071. eCollection 2018.
A meta-analysis that compared the onlay vs. sublay technique in open incisional hernia repair identified better outcomes for the sublay operation. Nonetheless, an Expert Consensus Guided by Systematic Review found the onlay mesh location useful in certain settings. Therefore, all studies on the onlay technique were once again collated and analyzed. A systematic search of the available literature was performed in August 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. For the present analysis 42 publications were identified as relevant. In five prospective randomized trials and 17 observational studies the postoperative complication rates ranged between 5 and 76%, with a mean value of 33.5%. The recurrence rates in these studies also ranged between 0 and 32%, with a mean value of 9.9%. Hence, compared with the literature data on the sublay operation, more post-operative complications, in particular wound complications and seroma, with a comparable recurrence rate, were identified. When the onlay technique is used in certain settings for incisional hernia repair, a careful dissection technique and prophylactic measures (drainage, abdominal binders, fibrin sealant) should be employed to prevent wound complications and seroma formation.
一项比较开放切口疝修补术中补片外置法与补片植入法的荟萃分析表明，补片植入手术的效果更好。尽管如此，一项基于系统评价的专家共识认为，在某些情况下补片外置位置是有用的。因此，再次对所有关于补片外置技术的研究进行了整理和分析。2018年8月，利用医学在线数据库（Medline）、美国国立医学图书馆生物医学信息数据库（PubMed）、斯高帕斯数据库（Scopus）、荷兰医学文摘数据库（Embase）、施普林格在线（Springer Link）和考科蓝图书馆，对现有文献进行了系统检索。在本次分析中，确定了42篇相关出版物。在5项前瞻性随机试验和17项观察性研究中，术后并发症发生率在5%至76%之间，平均值为33.5%。这些研究中的复发率也在0至32%之间，平均值为9.9%。因此，与补片植入手术的文献数据相比，发现采用补片外置技术术后并发症更多，尤其是伤口并发症和血清肿，而复发率相当。当在某些情况下使用补片外置技术进行切口疝修补时，应采用精细的解剖技术和预防措施（引流、腹部绷带、纤维蛋白封闭剂）以防止伤口并发症和血清肿形成。
