Marcolin Patricia, Mazzola Poli de Figueiredo Sérgio, Walmir de Araújo Sérgio, Mota Constante Marcella, Moura Fé de Melo Vítor, Ginar da Silva Shana, Mao Rui-Min Diana, DeJesus Jana, Lu Richard
School of Medicine.
Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
Surg Laparosc Endosc Percutan Tech. 2023 Apr 1;33(2):211-218. doi: 10.1097/SLE.0000000000001160.
Obesity is associated with an increased risk of ventral hernia development and recurrence rates after ventral hernia repair (VHR). The metabolic derangements caused by obesity can also lead to many postoperative complications. Therefore, it is a common practice to attempt weight loss before VHR. However, there is still no consensus on optimal preoperative management for obese patients with a ventral hernia. This study aims to perform a meta-analysis to evaluate the effect of preoperative weight optimization on VHR outcomes.
We performed a literature search of PubMed, Scopus, and Cochrane Library databases to identify studies comparing obese patients who underwent surgical or non-surgical weight loss interventions before undergoing hernia repair surgery to obese patients who underwent hernia repair surgery without prehabilitation. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I 2 statistics.
One thousand six hundred nine studies were screened and 13 were thoroughly reviewed. Five studies comprising 465 patients undergoing hernia repair surgery were included. No differences in hernia recurrence [odds ratio (OR) 0.66; 95% CI 0.23-1.89; P =0.44; I 2 =20%], seroma (OR 0.70; 95% CI 0.25-1.95; P =0.50; I 2 =5%), hematoma (OR 2.00; 95% CI 0.5-7.94; P =0.45; I 2 =0%), surgical site infection (OR 1.96; 95% CI 0.52-7.40; P =0.32; I 2 =0%), and overall complication (OR 0.80; 95% CI 0.37-1.74; P =0.58; I 2 =40%) rates were noted when comparing patients who underwent a preoperative weight loss intervention (prehabilitation or bariatric surgery) versus those who did not. In the subgroup analysis of patients who underwent bariatric surgery, we found no difference in hernia recurrence (OR 0.64; 95% CI 0.12-3.33; P = 0.59; I 2 =41%) or overall complications (OR 1.14; 95% CI 0.36-3.64; P =0.82; I 2 =64%). In the subgroup analysis of patients who lost weight versus patients who did not, there was no significant difference in overall complication rates (OR 0.86; 95% CI 0.34-2.21; P =0.76; I 2 =55%).
We found similar hernia recurrence, seroma, hematoma, and surgical site infection rates in patients who underwent preoperative optimization. These findings underline the need for prospective studies to define the optimal role of preoperative optimization and weight loss in obese patients undergoing ventral hernia repair.
肥胖与腹疝发生风险增加以及腹疝修补术（VHR）后的复发率升高相关。肥胖引起的代谢紊乱还可导致许多术后并发症。因此，在进行VHR之前尝试减肥是一种常见做法。然而，对于肥胖的腹疝患者，术前的最佳管理仍未达成共识。本研究旨在进行一项荟萃分析，以评估术前体重优化对VHR结局的影响。
我们对PubMed、Scopus和Cochrane图书馆数据库进行文献检索，以确定将在接受疝修补手术前接受手术或非手术减肥干预的肥胖患者与未进行术前准备而接受疝修补手术的肥胖患者进行比较的研究。通过汇总分析和荟萃分析评估术后结局。使用RevMan 5.4进行统计分析。用I²统计量评估异质性。
筛选了1609项研究，对其中13项进行了全面审查。纳入了5项研究，共465例接受疝修补手术的患者。比较接受术前减肥干预（术前准备或减重手术）的患者与未接受该干预的患者，发现疝复发率[比值比（OR）0.66；95%置信区间（CI）0.23 - 1.89；P = 0.44；I² = 20%]、血清肿（OR 0.70；95% CI 0.25 - 1.95；P = 0.50；I² = 5%）、血肿（OR 2.00；95% CI 0.5 - 7.94；P = 0.45；I² = 0%）、手术部位感染（OR 1.96；95% CI 0.52 - 7.40；P = 0.32；I² = 0%）及总体并发症发生率（OR 0.80；95% CI 0.37 - 1.74；P = 0.58；I² = 40%）均无差异。在接受减重手术患者的亚组分析中，我们发现疝复发率（OR 0.64；95% CI 0.12 - 3.33；P = 0.59；I² = 41%）或总体并发症发生率（OR 1.14；95% CI 0.36 - 3.64；P = 0.82；I² = 64%）无差异。在体重减轻患者与未减轻患者的亚组分析中，总体并发症发生率无显著差异（OR 0.86；95% CI 0.34 - 2.21；P = 0.76；I² = 55%）。
我们发现接受术前优化的患者疝复发、血清肿、血肿及手术部位感染率相似。这些发现强调需要进行前瞻性研究，以确定术前优化和减肥在肥胖腹疝修补患者中的最佳作用。
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