Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University Health Board, Pontyclun, UK.
Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth Hospital, Birmingham, UK.
Hernia. 2022 Aug;26(4):989-997. doi: 10.1007/s10029-021-02554-x. Epub 2022 Jan 10.
To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) in patients undergoing elective inguinal hernia repair.
In compliance with PRISMA statement standards, electronic databases were searched to identify all studies reporting the outcomes of TREPP in patients undergoing elective inguinal hernia repair. The outcomes of interest included recurrence, chronic pain, haematoma, and wound infection. Proportion meta-analysis model was constructed to quantify the risk of postoperative complications and direct comparison meta-analysis model was constructed to compare the outcomes of TREPP and other open techniques. Random-effects modelling was applied to calculate pooled outcome data.
Seven studies enrolling 1891 patients undergoing TREPP were included. The mean operative time was 26 min (95% CI 15-36). Pooled analyses showed that TREPP was associated with 3.00% (95% CI 1.00-6.00%) risk of recurrence, 3.00% (95% CI 2.00-6.00%) risk of chronic pain, 8.00% (95% CI 0.00-20.00%) risk of haematoma, and 3.00% (95% CI 0.00-6.00%) risk of wound infection. The results remained consistent through subgroup analysis of patients with primary hernias and those with recurrent hernias. Analysis of a limited number of comparative studies showed no difference between TREPP and Lichtenstein technique in terms of recurrence (OR 1.57, P = 0.26) and chronic pain (OR 1.16, P = 0.59).
The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. The available evidence is limited to studies from a same country conducted by almost the same research group which may affect generalisability of the findings. Moreover, there is a lack of comparative evidence on outcomes of TREPP versus other techniques highlighting a need for high-quality randomised controlled trials for definite conclusions. Although the available evidence is not adequate for definite conclusions, the results of current study can be used for sample size calculation and power analysis in future trials.
评估经腹横纹肌鞘外入路（TREPP）在择期腹股沟疝修补术中的应用效果。
根据 PRISMA 声明标准，检索电子数据库以确定所有报告 TREPP 治疗择期腹股沟疝修补术患者结局的研究。主要研究结局包括复发、慢性疼痛、血肿和伤口感染。采用比例meta 分析模型来量化术后并发症风险，采用直接比较 meta 分析模型来比较 TREPP 与其他开放式技术的疗效。应用随机效应模型来计算汇总结局数据。
纳入了 7 项纳入 1891 例患者的研究。平均手术时间为 26 分钟（95%CI：15-36）。汇总分析显示，TREPP 相关的复发风险为 3.00%（95%CI：1.00-6.00%），慢性疼痛风险为 3.00%（95%CI：2.00-6.00%），血肿风险为 8.00%（95%CI：0.00-20.00%），伤口感染风险为 3.00%（95%CI：0.00-6.00%）。亚组分析显示，原发性疝和复发性疝患者的结果一致。对有限数量的比较研究的分析表明，TREPP 与李金斯坦技术在复发（OR 1.57，P=0.26）和慢性疼痛（OR 1.16，P=0.59）方面无差异。
目前的最佳证据表明，TREPP 可能是一种有前途的腹股沟疝择期修复技术，其复发、慢性疼痛、血肿和伤口感染风险较低。但现有证据仅限于来自同一国家且由几乎同一研究小组进行的研究，这可能影响研究结果的普遍性。此外，缺乏 TREPP 与其他技术疗效的比较证据，因此需要高质量的随机对照试验来得出明确结论。虽然目前的证据还不足以得出明确的结论，但本研究的结果可用于未来试验的样本量计算和效能分析。
