Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, New Zealand.
Colorectal Surgical Unit, Chelsea and Westminster Hospital, Chelsea, London, UK.
Hernia. 2020 Dec;24(6):1361-1370. doi: 10.1007/s10029-020-02179-6. Epub 2020 Apr 16.
There is strong evidence suggesting that excessive fat distribution, for example, in the bowel mesentery or a reduction in lean body mass (sarcopenia) can influence short-, mid-, and long-term outcomes from patients undergoing various types of surgery. Body composition (BC) analysis aims to measure and quantify this into a parameter that can be used to assess patients being treated for abdominal wall hernia (AWH). This study aims to review the evidence linking quantification of BC with short- and long-term abdominal wall hernia repair outcomes.
A systematic review was performed according to the PRISMA guidelines. The literature search was performed on all studies that included BC analysis in patients undergoing treatment for AWH using Medline, Google Scholar and Cochrane databases by two independent reviewers. Outcomes of interest included short-term recovery, recurrence outcomes, and long-term data.
201 studies were identified, of which 4 met the inclusion criteria. None of the studies were randomized controlled trials and all were cohort studies. There was considerable variability in the landmark axial levels and skeletal muscle(s) chosen for analysis, alongside the methods of measuring the cross-sectional area and the parameters used to define sarcopenia. Only two studies identified an increased risk of postoperative complications associated with the presence of sarcopenia. This included an increased risk of hernia recurrence, postoperative ileus and prolonged hospitalisation.
There is some evidence to suggest that BC techniques could be used to help predict surgical outcomes and allow early optimisation in AWH patients. However, the lack of consistency in chosen methodology, combined with the outdated definitions of sarcopenia, makes drawing any conclusions difficult. Whether body composition modification can be used to improve outcomes remains to be determined.
有强有力的证据表明，过多的脂肪分布，例如肠系膜或瘦体重（肌肉减少症）的减少，可能会影响接受各种类型手术的患者的短期、中期和长期结局。身体成分（BC）分析旨在测量和量化这些参数，以用于评估接受腹壁疝（AWH）治疗的患者。本研究旨在回顾将 BC 定量与腹壁疝修复短期和长期结局联系起来的证据。
根据 PRISMA 指南进行系统评价。两名独立评审员通过 Medline、Google Scholar 和 Cochrane 数据库对所有纳入接受 AWH 治疗的患者进行 BC 分析的研究进行了文献检索。感兴趣的结局包括短期恢复、复发结局和长期数据。
确定了 201 项研究，其中 4 项符合纳入标准。没有一项研究是随机对照试验，所有研究都是队列研究。用于分析的标志性轴向水平和骨骼肌存在很大的差异，以及测量横截面积的方法和用于定义肌肉减少症的参数也存在很大的差异。只有两项研究确定了肌肉减少症与术后并发症风险增加之间存在关联。这包括疝复发、术后肠梗阻和住院时间延长的风险增加。
有一些证据表明，BC 技术可用于帮助预测手术结局，并允许 AWH 患者进行早期优化。然而，选择方法的一致性缺乏，加上肌肉减少症的定义已经过时，使得很难得出任何结论。身体成分的改变是否可以用来改善结局还有待确定。
