Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain.
Department of HPB Surgery and Transplantation, La Fe University Hospital, University of Valencia, Valencia, Spain.
Hernia. 2024 Aug;28(4):1427-1439. doi: 10.1007/s10029-024-03077-x. Epub 2024 Jun 5.
Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus Lichtenstein repair for inguinal hernia.
Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI).
Eight RCTs encompassing 1,469 patients randomized to Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92).
This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.
全球每年有超过 2000 万患者接受腹股沟疝修补术。手术是推荐的治疗方法，但缺乏对最佳方法的共识。本研究旨在进行更新的系统评价和荟萃分析，比较腹腔镜网片修补术（TAPP 和 TEP）与 Lichtenstein 修补术治疗腹股沟疝的慢性腹股沟疼痛和复发风险。
在 Ovid MEDLINE、PubMed、EBSCO、Cochrane 和 Google Scholar 中进行检索。纳入标准包括涉及成年人的随机对照试验（RCT），发表在英语和西班牙语中，比较 Lichtenstein 开放技术、TAPP 和/或 TEP 之间的手术结果。在方法学中遵循 PRISMA 指南，并使用 CASP 工具评估文章的质量。统计分析包括均值[±标准偏差（SD）]、比值比（OR）和置信区间（CI）。
纳入了 8 项 RCT，共纳入 1469 例随机分配至 Lichtenstein 修补术（n=755）和腹腔镜修补术（n=714）的患者。与 Lichtenstein 修补术相比，腹腔镜修补术慢性腹股沟疼痛的可能性较低（OR=0.28，95%CI [0.30-0.56]，p=0.0001）。腹腔镜组与 Lichtenstein 组的复发率无显著差异（OR=1.03，95%CI [0.57-1.86]，p=0.92）。
本系统评价和荟萃分析表明，与 Lichtenstein 修补术相比，腹腔镜疝手术导致慢性腹股沟疼痛的发生率较低，而复发率相似。
