Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, NHS Foundation Trust, Exeter, UK.
Hernia. 2020 Feb;24(1):9-21. doi: 10.1007/s10029-019-01961-5. Epub 2019 May 9.
Incisional hernia following closure of loop ileostomy is a common problem. Assessment of the proportion of this complication is limited by small sample size and inconsistent reporting. The aim of this review was to provide an estimate of the proportion of incisional hernia following closure of loop ileostomy according to clinical and radiological diagnostic criteria and to investigate the association of bibliometric and study quality parameters with reported proportion.
A systematic review of PubMed, Embase, CENTRAL, ISRCTN Registry and Open Grey from 2000 onwards was performed according to PRISMA standards. Reporting on the type of stoma and mesh reinforcement after closure was mandatory for inclusion, whereas studies on paediatric populations were excluded. Fixed effect or random effects models were used to calculate pooled proportion estimates. Meta-regression models were formed to explore potential heterogeneity.
42 studies with 7166 patients were included. The pooled estimate of the proportion of incisional hernia after ileostomy closure was 6.1% (95% confidence interval, CI 4.4-8.3%). Proportion estimates for higher quality studies and studies reporting on incisional hernia as primary outcome were 9.0% (95% CI 6.3-12.7%) and 13.1% (95% CI 8.8-19.1%). Significant between-study heterogeneity was identified (P < 0.001, I = 87%) and the likelihood of publication bias was high (P = 0.028). Mixed effects regression showed that both year of publication (P = 0.034, Q = 4.484, df = 1.000) and defining hernia as a primary outcome (Q = 20.298, P < 0.001) were related to effect size. Method of follow-up and quality of the studies affected the proportion.
The proportion of incisional hernia at ileostomy closure site is estimated at 6.1%. Reporting incisional hernia as primary or secondary outcome, the method of diagnosis, the year of publication and methodological quality are associated with reported proportion.
闭合袢式回肠造口术后发生切口疝是一个常见问题。由于样本量小且报告不一致，对这种并发症的比例评估受到限制。本综述的目的是根据临床和放射学诊断标准，提供闭合袢式回肠造口术后发生切口疝的比例估计，并探讨文献计量学和研究质量参数与报告比例的关系。
根据 PRISMA 标准，对 2000 年以来的 PubMed、Embase、CENTRAL、ISRCTN 注册中心和 Open Grey 进行系统综述。纳入标准为必须报告造口类型和闭合后使用的网片加固情况，排除儿科人群的研究。使用固定效应或随机效应模型计算汇总比例估计值。形成荟萃回归模型以探索潜在的异质性。
共纳入 42 项研究，共计 7166 例患者。闭合袢式回肠造口术后切口疝的汇总比例估计值为 6.1%（95%置信区间，4.4%-8.3%）。高质量研究和报告切口疝为主要结局的研究的比例估计值分别为 9.0%（95%置信区间，6.3%-12.7%）和 13.1%（95%置信区间，8.8%-19.1%）。研究间存在显著异质性（P<0.001，I=87%），且存在发表偏倚的可能性较高（P=0.028）。混合效应回归显示，发表年份（P=0.034，Q=4.484，df=1.000）和将疝定义为主要结局（Q=20.298，P<0.001）均与效应大小相关。随访方法和研究质量影响了比例。
闭合袢式回肠造口术后切口疝的比例估计为 6.1%。将切口疝作为主要或次要结局报告、诊断方法、发表年份和方法学质量与报告比例相关。
