Department of Surgery, Heidelberg University, Mannheim, Germany.
Department of Library and Information Sciences, Heidelberg University, Mannheim, Germany.
Obes Surg. 2019 Mar;29(3):1049-1057. doi: 10.1007/s11695-018-03687-2.
The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.
报道的减重手术中套管部位疝的发生率在 0.5%至 3%之间。最好的证据来源于回顾性研究分析前瞻性数据库，因此仅包括在腹腔镜减重手术后因套管部位疝出现症状或接受手术治疗的患者。进行了系统的文献检索，检索时间截至 2017 年 9 月。搜索策略包括“腹腔镜”和“减重手术”、“套管/端口”和“疝”这两个 MeSH 术语的适当组合。检索未受发表类型或语言的限制。综述在 PROSPERO（ID 85102）中进行注册，并按照 PRISMA 指南进行。纳入了 68 篇文献。汇总的疝发生率为 3.22%（范围 0-39.3%）。13 项试验报告了筋膜的系统闭合；12 项试验报告未进行筋膜闭合。数据可用性不允许进行汇总以计算相对风险。更高的 BMI 和使用成像方式进行特定的疝检查与套管部位疝的发生率显著增加相关。专门用于检测 TsH 的研究报告的汇总发生率为 24.5%。套管部位疝是微创多端口减重手术被低估的并发症。虽然没有高质量的试验可以精确计算发病率，但现有数据表明发病率非常高。减重手术中发生套管部位疝的危险因素尚未系统分析。该领域的前瞻性研究是必要的。
