Mena Jimmy, Azir Elia, Ahmed Rizwan, Ali Mohammad, Adesida Michael
General Surgery, Imperial College London, London, GBR.
General Surgery, Princess Royal Univeristy Hospital, London, GBR.
Cureus. 2024 Jan 2;16(1):e51535. doi: 10.7759/cureus.51535. eCollection 2024 Jan.
Abdominal wall reconstruction (AWR) is a surgical procedure performed to address various conditions such as hernias, incisional hernias, and complex abdominal wall defects. Mesh fixation plays a crucial role in providing mechanical reinforcement to the weakened abdominal wall during AWR. Traditionally, suturing has been the preferred method for mesh fixation; however, adhesion techniques using tissue adhesives or glues have gained attention as an alternative approach. This systematic review aims to compare suturing and adhesion techniques for mesh fixation in AWR and assess their effectiveness in preventing hernia recurrence. A comprehensive literature search was conducted across relevant databases, including PubMed, MEDLINE, Embase, and the Cochrane Library. Studies that fulfilled the predetermined eligibility criteria were included. The primary outcome measure of interest was hernia recurrence rates. Secondary outcomes included mesh-related complications, surgical site infections, patient-reported outcomes, and functional outcomes. A risk of bias assessment was performed for the included studies, and data were synthesized qualitatively. Overall, the results of the included studies suggest that atraumatic mesh fixation with glue may have the potential to reduce chronic groin pain (CGP). However, there were significant variations in patient selection criteria, glue administration techniques, and hernia repair methods among the trials, which limited the ability to draw definitive conclusions. Additionally, the definitions of CGP and measurement scales for postoperative pain varied across studies, making it challenging to compare outcomes. The limitations of the review include the small sample sizes in some trials, relatively short follow-up durations, and the lack of standardized criteria for assessing variables such as foreign body sensation and groin compliance. Furthermore, the economic implications of using glue fixation compared to traditional suture fixation need to be considered.
腹壁重建（AWR）是一种外科手术，用于治疗各种病症，如疝气、切口疝和复杂的腹壁缺损。在腹壁重建过程中，网片固定对于为薄弱的腹壁提供机械强化起着至关重要的作用。传统上，缝合一直是网片固定的首选方法；然而，使用组织粘合剂或胶水的粘连技术作为一种替代方法已受到关注。本系统评价旨在比较腹壁重建中网片固定的缝合技术和粘连技术，并评估它们在预防疝复发方面的有效性。我们在包括PubMed、MEDLINE、Embase和Cochrane图书馆在内的相关数据库中进行了全面的文献检索。纳入了符合预定纳入标准的研究。感兴趣的主要结局指标是疝复发率。次要结局包括与网片相关的并发症、手术部位感染、患者报告的结局和功能结局。对纳入的研究进行了偏倚风险评估，并对数据进行了定性综合分析。总体而言，纳入研究的结果表明，使用胶水进行无创伤性网片固定可能有降低慢性腹股沟疼痛（CGP）的潜力。然而，各试验之间在患者选择标准、胶水给药技术和疝修补方法方面存在显著差异，这限制了得出明确结论的能力。此外，不同研究中慢性腹股沟疼痛的定义和术后疼痛的测量量表各不相同，使得比较结局具有挑战性。该评价的局限性包括一些试验中的样本量较小、随访时间相对较短，以及缺乏评估诸如异物感和腹股沟顺应性等变量的标准化标准。此外，与传统缝合固定相比，使用胶水固定的经济影响也需要考虑。
