Leeds Institute of Emergency General Surgery, St James's University Hospital, Leeds, UK.
Leeds Institute of Medical Research, St James's University Hospital, University of Leeds, Leeds, UK.
BJS Open. 2024 May 8;8(3). doi: 10.1093/bjsopen/zrae068.
Umbilical hernias, while frequently asymptomatic, may become acutely symptomatic, strangulated or obstructed, and require emergency treatment. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate evidence gaps regarding emergency care of umbilical hernias.
EMBASE, MEDLINE and CENTRAL databases were searched using a predefined strategy until November 2023. Primary research studies reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Studies were excluded where emergency umbilical hernia care was not the primary focus and subsets of relevant data were unable to be extracted. Two independent reviewers screened abstracts and full texts, resolving disagreements by consensus or a third reviewer. Data were charted according to core concepts addressed by each study and a narrative synthesis was performed.
Searches generated 534 abstracts, from which 32 full texts were assessed and 14 included in the final review. This encompassed 52 042 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/14), split between single (6/14) and multicentre (8/14) with only one randomized trial. Most multicentre studies were from national databases (7/8). Themes arising included risk assessment (n = 4), timing of surgery (n = 4), investigations (n = 1), repair method (n = 8, four mesh versus suture; four laparoscopic versus open) and operative outcomes (n = 11). The most commonly reported outcomes were mortality (n = 9) and morbidity (n = 7) rates and length of hospital stay (n = 5). No studies included patient-reported outcomes specific to emergency umbilical hernia repair.
This scoping review demonstrates the paucity of high-quality data for this condition. There is a need for randomized trials addressing all aspects of emergency umbilical hernia repair, with patient-reported outcomes.
脐疝虽然通常无症状，但可能会突然出现症状、绞窄或梗阻，需要紧急治疗。在该领域需要有高质量的护理证据。本范围界定综述旨在阐明有关脐疝急救护理的证据差距。
使用预定义策略，在 EMBASE、MEDLINE 和 CENTRAL 数据库中进行搜索，直到 2023 年 11 月。符合纳入标准的研究是报告任何脐疝急救护理方面的原始研究，且以英文发表。如果急救脐疝护理不是主要焦点，且无法提取相关数据的子集，则排除研究。两名独立评审员筛选摘要和全文，通过共识或第三名评审员解决分歧。根据每项研究所涉及的核心概念对数据进行图表绘制，并进行叙述性综合。
搜索产生了 534 篇摘要，其中 32 篇全文进行了评估，最终有 14 篇纳入综述。这涵盖了 52042 例接受急救脐疝护理的患者。大多数为回顾性队列设计（14 篇中的 11 篇），分为单中心（14 篇中的 6 篇）和多中心（14 篇中的 8 篇），仅有一项随机试验。大多数多中心研究来自国家数据库（8 篇中的 7 篇）。出现的主题包括风险评估（n = 4）、手术时机（n = 4）、检查（n = 1）、修复方法（n = 8，4 个网片与缝线；4 个腹腔镜与开放）和手术结果（n = 11）。报告最多的结果是死亡率（n = 9）和发病率（n = 7）率以及住院时间（n = 5）。没有研究包括针对紧急脐疝修复的特定患者报告的结果。
本范围界定综述表明，该疾病缺乏高质量数据。需要有针对紧急脐疝修复的所有方面的随机试验，并纳入患者报告的结果。
