Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK.
, Flat 2, 8 Moorfield Road, Manchester, M20 2UY, UK.
Surg Endosc. 2021 Oct;35(10):5399-5413. doi: 10.1007/s00464-021-08554-3. Epub 2021 May 18.
Open and laparoscopic modalities are employed for treatment of sportsman's hernia with totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) laparoscopic approaches both currently being utilised. At present, neither subtype has demonstrated a beneficial superiority for sportsman's hernia repair, as concluded in the most recent systematic review comparing the outcomes of each technique. The aim of this review was to evaluate current evidence to ascertain whether there was a difference in laparoscopic techniques following sportsman's hernia repair.
A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Databases searched included PubMed, Scopus and Web of Science to identify all randomised controlled trials (RCTs) and observational studies Risk of bias was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale for RCTs and observational studies, respectively.The assessed outcomes included median time to return to sporting activity, complications and the degree of postoperative pain reduction within three months. Random effects model was used to calculate pooled proportion data where feasible. Subgroup analyses were also performed.
28 studies were identified including 2 RCTs and 26 observational studies. No significant differences were observed between techniques in the primary or secondary outcomes. Significant heterogeneity was observed in all outcomes. This was more pronounced for return to sporting activity meaning that meta-analysis was not feasible in this domain. Median time to return to sporting activity was 28 days for both techniques.
There is no observed difference in the primary and secondary outcomes in either technique. An RCT comparing TEP and TAPP repair is needed to provide definitive data on this matter.
开放和腹腔镜方法都被用于治疗运动员疝，完全腹膜外（TEP）和经腹腹膜前（TAPP）腹腔镜方法目前都在使用。目前，正如最近的一项系统评价比较每种技术的结果所得出的结论，这两种亚型都没有表现出对运动员疝修补术的有益优势。本综述的目的是评估当前的证据，以确定在运动员疝修补术后，腹腔镜技术是否存在差异。
根据系统评价和荟萃分析的首选报告项目（PRISMA）标准进行系统文献检索。搜索的数据库包括 PubMed、Scopus 和 Web of Science，以确定所有随机对照试验（RCT）和观察性研究。使用 Cochrane 风险偏倚工具和纽卡斯尔-渥太华量表分别评估 RCT 和观察性研究的风险偏倚。评估的结果包括返回运动活动的中位时间、并发症和术后三个月内疼痛减轻的程度。如果可行，使用随机效应模型计算汇总比例数据。还进行了亚组分析。
共确定了 28 项研究，包括 2 项 RCT 和 26 项观察性研究。在主要或次要结果中，两种技术之间没有观察到显著差异。所有结果均观察到显著的异质性。在返回运动活动方面更为明显，这意味着在该领域进行荟萃分析是不可行的。两种技术的中位返回运动活动时间均为 28 天。
两种技术在主要和次要结果方面均无差异。需要一项比较 TEP 和 TAPP 修复的 RCT 来提供关于这一问题的明确数据。
