Chai Shion Wei, Chiang Po-Hsing, Chien Chin-Ying, Chen Yi-Chan, Soong Ruey-Shyang, Huang Ting-Shuo
Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan.
Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Chin Road, Keelung, 20401, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, 259, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, 20401, Taiwan.
Asian J Surg. 2022 Apr;45(4):981-986. doi: 10.1016/j.asjsur.2021.08.058. Epub 2021 Sep 9.
Hernia repair techniques have evolved recently; however sac handling remains a critical step. Transection of the herniated sac as opposed to total sac reduction may simplify the procedure. However, residual sac tissue may increase the risk for seroma formation. We performed a systemic review and meta-analysis to evaluate the safety and feasibility of transecting the hernia sac during laparoscopic herniorrhaphy. Relevant literature search was performed in PubMed, EMBASE, SCORPUS, and the Cochrane Library databases. Relevant studies that compared total reduction with transection of the herniated sac during laparoscopic herniorrhaphy were included. The primary outcome measure was the incidence of seromas. We also analyzed secondary outcomes including operative duration, postoperative pain scores, complications, and hernia recurrence rate. Of the 330 studies identified, four studies published between 2002 and 2020, with sample sizes ranging from 70 to 520 patients, met the inclusion criteria. Overall, 848 hernias were evaluated. We observed a high incidence of seroma formation in the sac transection group compared to that in the sac reduction group (OR 2.41; 95% CI 1.39 to 4.17, P = 0.002), but the groups did not differ significantly with respect to factor such as operative duration, postoperative complications, and pain score. Herniated sac transection during laparoscopic herniorrhaphy might be associated with a higher risk of seroma formation than that observed with sac reduction. The former approach did not show any significant benefits compared to the latter approach with respect to operative duration and postoperative complications.
近年来，疝修补技术不断发展；然而，疝囊处理仍然是关键步骤。与完全回纳疝囊相反，横断疝出的疝囊可能会简化手术过程。然而，残留的疝囊组织可能会增加血清肿形成的风险。我们进行了一项系统评价和荟萃分析，以评估腹腔镜疝修补术中横断疝囊的安全性和可行性。在PubMed、EMBASE、SCORPUS和Cochrane图书馆数据库中进行了相关文献检索。纳入了比较腹腔镜疝修补术中完全回纳疝囊与横断疝出疝囊的相关研究。主要结局指标是血清肿的发生率。我们还分析了次要结局，包括手术时间、术后疼痛评分、并发症和疝复发率。在检索到的330项研究中，2002年至2020年发表的4项研究符合纳入标准，样本量从70例至520例患者不等。总体而言，共评估了848例疝。我们观察到，与疝囊回纳组相比，疝囊横断组血清肿形成的发生率较高（比值比2.41；95%置信区间1.39至4.17，P = 0.002），但两组在手术时间、术后并发症和疼痛评分等因素方面无显著差异。腹腔镜疝修补术中横断疝出的疝囊可能比疝囊回纳术血清肿形成风险更高。与后者相比，前者在手术时间和术后并发症方面未显示出任何显著优势。
