School of Medicine, University of Auckland, Auckland, New Zealand.
Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand.
Hernia. 2023 Oct;27(5):1047-1057. doi: 10.1007/s10029-023-02785-0. Epub 2023 Apr 3.
Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk.
Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots.
Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair.
Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
腹腔镜疝修补术（LH）已成为许多中心治疗腹股沟疝（IH）患者的首选方法。我们的目的是比较使用腹腔镜完全腹膜外（TEP）技术治疗双侧与单侧 IH 修复的发病率结果，以确定进行双侧 IH 修复是否会使患者面临额外的风险。
在 PubMed/MEDLINE、EMBASE、Cochrane 图书馆、Scopus 和 Web of Science 上搜索截至 2021 年底发表的文献。确定接受单侧或双侧 TEP 手术的患者（年龄>16 岁），使用标准的 3 端口腹腔镜技术进行。使用 GRADE 标准评估证据质量。在可能的情况下进行荟萃分析。在不可能进行荟萃分析的情况下，使用效应方向图进行计数投票。
共纳入 8 项观察性研究，总计 18153 例患者。双侧手术的手术时间明显延长。中转开放、术后血清肿、尿潴留、血肿和住院时间无显著差异。行双侧 IH 修复的患者疝复发率增加。
尽管受纳入研究的观察性质限制，但没有确凿的证据表明单侧和双侧 TEP IH 修复的发病率存在差异。由于所有纳入的论文均来自观察性研究，因此所有结局的证据充其量只是低质量。本研究强调需要在这一领域开展随机对照试验。
