Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, BP: 234, Nationale 2, Route de Ngallele, Saint-Louis, Senegal.
Department of Surgery, Assane Seck University, Ziguinchor, Senegal.
Hernia. 2023 Feb;27(1):157-172. doi: 10.1007/s10029-022-02669-9. Epub 2022 Sep 6.
To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa.
We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia.
We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)].
This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.
对撒哈拉以南非洲地区成人腹股沟疝手术进行系统评价。
我们进行了系统评价和荟萃分析，主要目的是确定撒哈拉以南非洲地区单侧腹股沟疝手术中使用的手术技术。考虑了过去 20 年发表的研究。荟萃分析估计了死亡率、慢性疼痛和复发的合并患病率及其 95%置信区间（CI）。亚组分析比较了复杂疝和非复杂疝的并发症发生率。
我们纳入了 113 篇文章。最常用的技术是 Bassini 占 40.1%，其次是 Lichtenstein 占 29.9%和 Shouldice 占 12.6%。总体死亡率为 0.6%（95%CI 0.4-0.9）。合并复发率为 1.4%（95%CI 1.05-1.9）。合并慢性疼痛率为 2.7%（95%CI 1.9-3.7）。我们发现复杂疝（6.4%）的死亡率高于非复杂疝（0.2%）。这种差异具有统计学意义[P≤0.001；OR=47.7；95%CI（27.2-83.47）]。
本综述表明，纯组织修复是最常用的技术，Bassini 和 Shouldice 是主要的手术方法。术后复发和慢性疼痛的发生率较低。然而，研究之间存在高度异质性，可能会低估这些合并患病率。并发症阶段的咨询仍然很频繁，且与较高的死亡率相关。未来的研究应侧重于提高设计和随访方面的研究质量，以提高证据水平。
