Tryliskyy Y, Wong C S, Demykhova I, Tyselskyi V, Kebkalo A, Poylin V, Pournaras D J
Severn PGME School of Surgery, Bristol, UK.
The University of Edinburgh, Edinburgh, UK.
Hernia. 2022 Dec;26(6):1473-1481. doi: 10.1007/s10029-021-02533-2. Epub 2021 Nov 8.
Several studies have examined effectiveness of primary fascial defect closure (FDC) versus bridged repair (no-FDC) during laparoscopic ventral hernia mesh repair (LVHMR). The purpose of this study was to systematically review and meta-analyse randomized controlled trials (RCTs) which compared safety and effectiveness of two techniques.
Systematic literature searches (EMBASE, MEDLINE, PubMed, and CINAHL) were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines using predefined terms. RCTs comparing FDC and no-FDC in LVHMR were identified and retrieved. Primary outcomes were risk of recurrence and risk of major complications analyzed as a single composite outcome. Secondary outcomes were risks of seroma formation, clinical or radiologically confirmed eventration, incidence of readmission to hospital, postoperative changes in quality of life (QoL), and postoperative pain. Random effects modeling to summarize statistics were performed. The risk of bias was assessed using Cohrane's Risk of Bias tool 2.
Three RCTs that enrolled total of 259 patients were included. There was clinical heterogeneity present between studies related to patients' characteristics, hernia characteristics, and operative techniques. There was no difference found in primary outcomes, risks of seroma formation, eventration, and chronic pain. There is conflicting evidence on how both techniques affect postoperative QoL or early postoperative pain.
Both techniques were detected to have equal safety profile and do not differ in risk of recurrence, seroma formation, risks of clinical or radiological eventration. Giving uncertainty and clinical equipoise, another RCT examining FDC vs no-FDC laparoscopic mesh repair separately for primary and secondary hernias using narrow inclusion criteria for hernia size on well-defined population would be ethical and pragmatic.
CRD42021274581.
多项研究探讨了腹腔镜腹疝修补术（LVHMR）中一期筋膜缺损闭合（FDC）与桥接修补（非FDC）的有效性。本研究的目的是系统评价和荟萃分析比较这两种技术安全性和有效性的随机对照试验（RCT）。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用预定义术语进行系统文献检索（EMBASE、MEDLINE、PubMed和CINAHL）。识别并检索比较LVHMR中FDC和非FDC的RCT。主要结局是将复发风险和主要并发症风险作为单一综合结局进行分析。次要结局是血清肿形成风险、临床或影像学证实的脏器突出、再次入院发生率、术后生活质量（QoL）变化以及术后疼痛。采用随机效应模型汇总统计数据。使用Cohrane偏倚风险工具2评估偏倚风险。
纳入了3项共纳入259例患者的RCT。研究之间在患者特征、疝特征和手术技术方面存在临床异质性。在主要结局、血清肿形成风险、脏器突出和慢性疼痛方面未发现差异。关于这两种技术如何影响术后QoL或术后早期疼痛，存在相互矛盾的证据。
两种技术的安全性相当，在复发风险、血清肿形成、临床或影像学脏器突出风险方面没有差异。鉴于存在不确定性和临床 equipoise，另一项针对原发性和继发性疝分别使用狭窄的疝大小纳入标准在明确界定的人群中比较FDC与非FDC腹腔镜补片修补术的RCT将是符合伦理和务实的。
PROSPERO注册：CRD42021274581。
