Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy.
Hernia. 2020 Aug;24(4):707-715. doi: 10.1007/s10029-020-02146-1. Epub 2020 Feb 24.
To examine the updated evidence on safety, effectiveness, and outcomes of mesh versus suture elective umbilical hernia (UH) repair and to explore the timely tendency variations favouring one treatment over another.
MEDLINE and CENTRAL databases were consulted. A systematic review, pairwise meta-analysis, and trial sequential analysis (TSA) were conducted.
Six RCTs were included for a total of 742 patients. Overall, 383 (51.6%) underwent mesh, while 359 (48.4%) underwent suture repair. The estimated pooled postoperative recurrence RR was 0.27 (95% CI 0.13-0.53; p < 0.001). The TSA showed a statistically significant timely tendency in favour of mesh repair with a boundary cross curve (Z = 1.96) before reaching the information size. The estimated pooled seroma, haematoma, and wound infection RR were 1.45 (p = 0.368), 0.54 (p = 0.196), and 0.71 (p = 0.375), respectively. The TSA for wound-related complications showed partial, non-significant results.
Elective UH mesh repair seems to be associated with reduced risk of postoperative recurrence compared to simple suture repair with a statistically significant timely trend endorsed by the TSA. Definitive considerations concerning the cumulative effect for seroma, haematoma, and wound infection are premature. Further studies are warranted to endorse these results and deeply investigate the timely tendency variations.
考察关于网片与缝线选择性脐疝（UH）修复的安全性、有效性和结局的最新证据，并探讨有利于一种治疗方法而非另一种治疗方法的及时趋势变化。
检索 MEDLINE 和 CENTRAL 数据库。进行了系统评价、成对荟萃分析和试验序贯分析（TSA）。
共纳入 6 项 RCT，总计 742 例患者。总体而言，383 例（51.6%）接受了网片修复，359 例（48.4%）接受了缝线修复。估计术后复发的 RR 为 0.27（95%CI 0.13-0.53；p<0.001）。TSA 显示，在达到信息大小之前，网片修复具有统计学意义的及时趋势，跨越了边界交叉曲线（Z=1.96）。估计的血清肿、血肿和伤口感染的 RR 分别为 1.45（p=0.368）、0.54（p=0.196）和 0.71（p=0.375）。关于伤口相关并发症的 TSA 显示部分结果无统计学意义。
与单纯缝线修复相比，选择性 UH 网片修复似乎与术后复发风险降低相关，TSA 支持这一具有统计学意义的及时趋势。关于血清肿、血肿和伤口感染的累积效应的明确结论还为时过早。需要进一步的研究来支持这些结果，并深入探讨及时趋势变化。
