Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA.
Department of Pediatrics, Memorial Hermann Children's Hospital, McGovern Medical School at UTHealth, Houston, Texas, USA.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa020.
Contralateral clinically occult hernias are frequently noted at the time of laparoscopic unilateral inguinal hernia repair. There is no consensus on the role of contralateral exploration and repair. This systematic review assessed the safety and efficacy of operative repair of occult contralateral inguinal hernias found during unilateral repair.
PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to February 2020. Adults diagnosed with a unilateral inguinal hernia undergoing laparoscopic repair were included. The primary outcome was the incidence of occult contralateral hernias. Summative outcomes of operative and expectant management were reported along with development of a Markov decision process.
Thirteen studies (1 randomized trial, 12 observational cohorts) with 5000 patients were included. The incidence of occult contralateral inguinal hernias was 14.6 (range 7.3-50.1) per cent. Among patients who underwent repair, 10.5 (4.3-17.0) per cent experienced a postoperative complication. Of patients managed expectantly, 29 per cent later required elective repair for symptoms. Mean follow-up was 36 (range 2-218) months. Using a Markov decision process, it was calculated that, for every 1000 patients undergoing unilateral inguinal hernia repair, contralateral exploration would identify 150 patients with an occult hernia. Repair would result in 15 patients developing a postoperative complication and 105 undergoing unnecessary repair. Alternatively, expectant management would result in 45 patients requiring subsequent repair.
Contralateral repair is not warranted in patients with occult hernias diagnosed at the time of elective hernia repair. The evidence is largely based on observational studies at high risk of bias.
在腹腔镜单侧腹股沟疝修补术时，经常会发现对侧隐匿性疝。对于对侧探查和修补的作用尚无共识。本系统评价评估了在单侧修复时发现隐匿性对侧腹股沟疝的手术修复的安全性和有效性。
从建库至 2020 年 2 月，检索了 PubMed、Embase 和 Cochrane 对照试验中心注册库。纳入诊断为单侧腹股沟疝并接受腹腔镜修补术的成年人。主要结局是隐匿性对侧疝的发生率。报告了手术和期待治疗的综合结局，并制定了马尔可夫决策过程。
纳入了 13 项研究（1 项随机试验，12 项观察性队列研究），共 5000 例患者。隐匿性对侧腹股沟疝的发生率为 14.6％（范围 7.3-50.1）。在接受修复的患者中，10.5％（4.3-17.0）发生术后并发症。在接受期待治疗的患者中，29％的患者随后因症状需要择期修复。平均随访时间为 36 个月（范围 2-218）。使用马尔可夫决策过程计算，对于每 1000 例接受单侧腹股沟疝修补术的患者，对侧探查将发现 150 例隐匿性疝患者。修复会导致 15 名患者发生术后并发症和 105 名患者进行不必要的修复。或者，期待治疗会导致 45 名患者需要后续修复。
在择期疝修补术时诊断为隐匿性疝的患者，不建议进行对侧修补。该证据主要基于高偏倚风险的观察性研究。
