Jensen Sofie Anne-Marie Skovbo, Fonnes Siv, Gram-Hanssen Anders, Andresen Kristoffer, Rosenberg Jacob
Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
Surgery. 2021 Jun;169(6):1268-1277. doi: 10.1016/j.surg.2020.12.027. Epub 2021 Feb 17.
Various surgical approaches are available for cholecystectomy, but their long-term outcomes, such as incidence of incisional hernia, are largely unknown. Our aim was to investigate the long-term incidence of incisional hernia after cholecystectomy for different surgical approaches.
This systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42020178906). Three databases were searched for original studies on long-term complications of cholecystectomy with n > 40 and follow-up ≥6 months for incisional hernia. Risk of bias within the studies was assessed using the Newcastle-Ottawa Scale and the Cochrane "risk of bias" tool. Meta-analysis of the incidence of incisional hernia after 6 and 12 months was conducted when possible.
We included 89 studies. Of these, 77 reported on multiport or single-incision laparoscopic cholecystectomy. Twelve studies reported on open cholecystectomy and 4 studies on robotic cholecystectomy. Weighted mean incidence proportion of incisional hernia after multi-port laparoscopic cholecystectomy was 0.3% (95% confidence interval 0-0.6) after 6 months and 0.2% after 12 months (95% confidence interval 0.1-0.3). Weighted mean incidence of incisional hernia 12 months postoperatively was 1.5% (95% confidence interval 0.4-2.6) after open cholecystectomy and 4.5% (95% confidence interval 0.4-8.6) after single-incision laparoscopic cholecystectomy. No meta-analysis could be conducted for robotic cholecystectomy, but incidences ranged from 0% to 16.7%.
We found low 1-year incidences of incisional hernia after multiport laparoscopic and open cholecystectomy, whereas risks of incisional hernia were considerably higher after single-incision laparoscopic and robotic cholecystectomy.
胆囊切除术有多种手术方式，但它们的长期结局，如切口疝的发生率，在很大程度上尚不清楚。我们的目的是研究不同手术方式的胆囊切除术后切口疝的长期发生率。
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目指南进行报告。一项方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42020178906）登记。检索了三个数据库，以查找关于胆囊切除术后长期并发症且样本量n>40以及切口疝随访时间≥6个月的原始研究。使用纽卡斯尔-渥太华量表和Cochrane“偏倚风险”工具评估研究中的偏倚风险。尽可能对6个月和12个月后的切口疝发生率进行荟萃分析。
我们纳入了89项研究。其中，77项报告了多端口或单切口腹腔镜胆囊切除术。12项研究报告了开腹胆囊切除术，4项研究报告了机器人辅助胆囊切除术。多端口腹腔镜胆囊切除术后6个月切口疝的加权平均发生率为0.3%（95%置信区间0-0.6），12个月后为0.2%（95%置信区间0.1-0.3）。开腹胆囊切除术后12个月切口疝的加权平均发生率为1.5%（95%置信区间0.4-2.6），单切口腹腔镜胆囊切除术后为4.5%（95%置信区间0.4-8.6）。无法对机器人辅助胆囊切除术进行荟萃分析，但其发生率在0%至16.7%之间。
我们发现多端口腹腔镜和开腹胆囊切除术后1年切口疝发生率较低，而单切口腹腔镜和机器人辅助胆囊切除术后切口疝风险明显更高。
