Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Louvain - University of Leuven, 3000, Leuven, Belgium.
Surg Endosc. 2024 Sep;38(9):4831-4838. doi: 10.1007/s00464-024-11118-w. Epub 2024 Aug 7.
The repair of inguinal hernias is a common surgical procedure. Some patients will need a second operation after developing a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary unilateral surgery. In this systematic review we aim to determine how many adult patients with a unilateral inguinal hernia will develop a MCIH.
This review was reported in line with PRISMA guidelines. We performed a literature review in PubMed Publisher, Embase, Google Scholar and Cochrane Library until May 2021, including articles reporting MCIH after unilateral inguinal hernia repair in adults. As outcome measure, the number of patients diagnosed with a MCIH was registered.
A total of 19 articles with a total of 277,288 patients were included. The combined estimate for MCIH after meta-analysis equaled 8.3% (95% CI 7.1%-9.5%), with a high index of heterogeneity (I = 97.9%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated at 5.2%, 8.0% and 17.1%, respectively.
We suggest that there is insufficient clinical evidence to support prophylactic contralateral repair in all patients. We propose a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors for hernia development, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long-term prospective data are needed to guide the decision for prophylactic contralateral mesh placement.
腹股沟疝修补术是一种常见的外科手术。一些患者在出现对侧腹股沟疝（MCIH）后需要再次手术。有人建议在进行单侧原发性手术的同时加强对侧。在这项系统评价中，我们旨在确定有多少单侧腹股沟疝的成年患者会发展为 MCIH。
本综述按照 PRISMA 指南进行报告。我们在 PubMed 出版商、Embase、Google Scholar 和 Cochrane Library 中进行了文献检索，检索时间截至 2021 年 5 月，包括报告成人单侧腹股沟疝修补术后发生 MCIH 的文章。作为结局指标，记录了诊断为 MCIH 的患者数量。
共纳入 19 篇文章，总计 277288 例患者。荟萃分析后的合并估计 MCIH 发生率为 8.3%（95%CI 7.1%-9.5%），异质性指数高（I=97.9%）。进行了随机效应荟萃回归，以获得 MCIH 百分比作为中位随访时间的函数。估计 3、5 和 10 年的 MCIH 发生率分别为 5.2%、8.0%和 17.1%。
我们认为，目前还没有足够的临床证据支持对所有患者预防性修复对侧。我们建议在决定进行预防性修复时采用个体化方法，考虑疝发生的潜在危险因素、手术方式类型以及慢性术后腹股沟疼痛的一般危险因素。需要更多的长期前瞻性数据来指导预防性对侧网片放置的决策。
