Yang Chun, Deng Shaoping
Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China.
Ann Palliat Med. 2020 May;9(3):1164-1173. doi: 10.21037/apm-20-968.
Inguinal hernia repair is a common surgical procedure; however, the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia are unclear. This study aimed to evaluate the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia by conducting a meta-analysis of randomized controlled trials (RCTs).
A comprehensive, meta-analysis of RCTs on the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia was performed. English- and Chinese-language studies published up to December 30, 2017 were identified via a systematic search of the PubMed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Summary odd ratios or weighted mean differences (MDs) with 95% confidence intervals (CIs) were adopted to calculate each outcome using a fixed or random effects model.
Ten RCTs involving a total of 1,017 patients were included. There was no statistically significant difference in the rate of recurrence (P=0.23; OR: 0.74, 95% CI: 0.45-1.21), hematoma (P=0.47; OR: 0.71, 95% CI: 0.28-1.79), urinary retention (P=0.94; OR: 0.97, 95% CI: 0.46-2.07) and acute pain (P=0.71; OR: 0.74, 95% CI: 0.14-3.76) between the laparoscopic and open mesh repair groups. The incision infection rate (P=0.02; OR: 0.28, 95% CI: 0.10-0.81) of the laparoscopic group was lower and the length of hospital stay (P<0.0001; MD: -3.65, 95% CI: -4.76 to -2.53) was significantly shorter than those of the open repair group. However, the laparoscopic group had a longer operative time (P=0.0002; MD: 20.30, 95% CI: 9.60-31.01).
The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.
腹股沟疝修补术是一种常见的外科手术；然而，腹腔镜和开放网片修补术治疗复发性腹股沟疝的效果尚不清楚。本研究旨在通过对随机对照试验（RCT）进行荟萃分析，评估腹腔镜和开放网片修补术治疗复发性腹股沟疝的效果。
对腹腔镜和开放网片修补术治疗复发性腹股沟疝效果的RCT进行全面的荟萃分析。通过系统检索PubMed、Embase、Science Direct、Cochrane对照试验中央注册库、中国知网（CNKI）和万方数据库，确定截至2017年12月30日发表的英文和中文研究。采用固定效应模型或随机效应模型，计算各结局的汇总比值比或加权平均差（MD）及95%置信区间（CI）。
纳入10项RCT，共1017例患者。腹腔镜组和开放网片修补组在复发率（P = 0.23；OR：0.74，95%CI：0.45 - 1.21）、血肿（P = 0.47；OR：0.71，95%CI：0.28 - 1.79）、尿潴留（P = 0.94；OR：0.97，95%CI：0.46 - 2.07）和急性疼痛（P = 0.71；OR：0.74，95%CI：0.14 - 3.76）方面无统计学显著差异。腹腔镜组的切口感染率（P = 0.02；OR：0.28，95%CI：0.10 - 0.81）较低，住院时间（P < 0.0001；MD： - 3.65, 95%CI： - 4.76至 - 2.53）明显短于开放修补组。然而，腹腔镜组的手术时间较长（P = 0.0002；MD：20.30，95%CI：9.60 - 31.01）。
在某些方面，包括切口感染率和住院时间，腹腔镜手术方法优于开放网片修补术治疗复发性腹股沟疝。然而，仍需要更多关于腹腔镜和开放网片修补术治疗复发性腹股沟疝效果的高质量研究。
