Severn PGME School of Surgery, Bristol, United Kingdom the University of Edinburgh, Edinburgh, United Kingdom.
P.L. Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.
Pol Przegl Chir. 2023 Feb 17;95(4):1-5. doi: 10.5604/01.3001.0016.2728.
This systematic review and meta-analysis analysed was set up to compare totally extraperitoneal mesh repair (TEP) and intraperitoneal onlay mesh placement (IPOM) in patients undergoing minimally invasive ventral hernia mesh surgery (MIS-VHMS).
A systematic literature searches of three major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies that compared two techniques of MIS-VHMS: TEP and IPOM. Primary outcome of interest was major complications post-operatively, defined as a composite outcome of surgical-site occurrences requiring procedural intervention (SSOPI), readmission to hospital, recurrence, reoperation or death. Secondary outcomes were intraoperative complications, duration of surgery, surgical site occurrence (SSO), SSOPI, postoperative ileus, post-operative pain. The risk of bias was assessed using Cohranes Risk of Bias tool 2 for randomized controlled trials (RCTs) and Newcastle-Ottawa score for observational studies (OSs).
Five OSs and two RCTs al including total number of 553 patients were included. There was no difference in primary outcome (RD 0.00 [-0.05, 0.06], p=0.95), incidence of postoperative ileus. Operative time was longer in TEP (MD 40.10 [27.28, 52.91], p<0.01). TEP was found to be associated with less postoperative pain at 24h and 7days after surgery.
Both TEP and IPOM were detected to have equal safety profile and do not differ in SSO or SSOPI rates, incidence of postoperative ileus. TEP has longer operative time but provides better early postoperative pain outcomes. Further high-quality studies with long follow up evaluating recurrence and patient reported outcomes are needed. Comparison of other transabdominal and extraperitoneal MIS-VHMS techniques is another direction of future research. PROSPERO registration: CRD4202121099.
本系统评价和荟萃分析旨在比较经微创腹疝网片修补术（MIS-VHMS）中完全腹膜外网片修补术（TEP）和腹腔内网片放置术（IPOM）。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对三个主要数据库进行系统文献检索，以确定比较两种 MIS-VHMS 技术的研究：TEP 和 IPOM。主要观察指标为术后主要并发症，定义为需要手术干预的手术部位并发症（SSOPI）、再次住院、复发、再次手术或死亡的综合结果。次要结局为术中并发症、手术时间、手术部位发生（SSO）、SSOPI、术后肠梗阻、术后疼痛。使用 Cochrane 偏倚风险工具 2 对随机对照试验（RCT）和纽卡斯尔-渥太华量表对观察性研究（OS）进行风险评估。
纳入了 5 项 OS 和 2 项 RCT，共纳入了 553 例患者。两组患者在主要结局（RD 0.00 [-0.05, 0.06]，p=0.95）和术后肠梗阻发生率方面无差异。TEP 的手术时间较长（MD 40.10 [27.28, 52.91]，p<0.01）。TEP 术后 24 小时和 7 天疼痛程度较低。
TEP 和 IPOM 均具有相同的安全性，在 SSO 或 SSOPI 发生率、术后肠梗阻发生率方面无差异。TEP 手术时间较长，但术后早期疼痛缓解效果更好。需要进一步进行高质量、随访时间长的研究，以评估复发和患者报告的结局。比较其他经腹腔和腹膜外 MIS-VHMS 技术是未来研究的另一个方向。PROSPERO 注册号：CRD4202121099。
