Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy.
Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy.
Ann Surg. 2021 Dec 1;274(6):954-961. doi: 10.1097/SLA.0000000000004735.
Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia.
Systematic review and network meta-analyses of randomized controlled trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference.
Thirty-five RCTs (7777 patients) were included. Overall, 3496 (44.9%) underwent Lichtenstein, 1269 (16.3%) TAPP, and 3012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12 hours, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs Lichtenstein (WMD = -3.3; 95% CrI -4.9 to -1.8) and TEP vs Lichtenstein (WMD = -3.6; 95% CrI -4.9 to -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches, whereas no differences were found for seroma, hernia recurrence, and hospital length of stay.
Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
尽管出现了创新的外科平台和手术技术，但对于单侧原发性腹股沟疝的最佳手术选择仍未确定。目的是对腹股沟疝的主要治疗方法进行最新和全面的评估。
对随机对照试验（RCT）进行系统评价和网络荟萃分析，比较了 Lichtenstein 无张力修补术、腹腔镜经腹腹膜前修补术（TAPP）和完全腹膜外修补术（TEP）。风险比（RR）和加权均数差（WMD）用作汇总效应量的指标，95%可信区间（CrI）用于评估相对推断。
共纳入 35 项 RCT（7777 例患者）。总体而言，3496 例（44.9%）接受了 Lichtenstein 手术，1269 例（16.3%）接受了 TAPP 手术，3012 例（38.8%）接受了 TEP 手术。在 12 小时、24 小时和 48 小时时，微创修复的视觉模拟量表（VAS）明显较低。术后慢性疼痛[TAPP 与 Lichtenstein（RR=0.36；95%CrI0.15-0.81）和 TEP 与 Lichtenstein（RR=0.36；95%CrI0.21-0.54）]和恢复工作/活动[TAPP 与 Lichtenstein（WMD=-3.3；95%CrI-4.9 至-1.8）和 TEP 与 Lichtenstein（WMD=-3.6；95%CrI-4.9 至-2.4）]明显减少。微创方法显著降低了切口血肿和感染的发生率，而血清肿、疝复发和住院时间的差异无统计学意义。
与 Lichtenstein 无张力修补术相比，微创 TAPP 和 TEP 修复似乎与术后早期疼痛、恢复工作/活动、慢性疼痛、血肿和伤口感染明显减少相关。疝复发、血清肿和住院时间在不同治疗方法之间似乎相似。
