Department of General Surgery, Heliopolis Hospital, São Paulo, Brazil.
USCS - University of São Caetano do Sul, São Paulo, Brazil.
World J Surg. 2024 Nov;48(11):2615-2628. doi: 10.1002/wjs.12360. Epub 2024 Sep 29.
The Lichtenstein technique is the gold standard for adult open inguinal hernia repair with mesh. The Desarda technique emerged in 2001 as a novel, promising non-mesh technique that has demonstrated low recurrence and postoperative complications.
We searched MEDLINE, the Cochrane Central Register of Clinical Trials, and Embase for randomized controlled trials (RCT) published until April 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q test and I statistics, with p-values <0.10 and I>25% considered significant. Statistical analysis was performed using the R software, version 4.1.2.
Eighteen RCTs comprising 1756 patients were included, of whom 861 (49%) were submitted to Desarda and 895 (51%) were submitted to Lichtenstein. Desarda was associated with lower seroma rates (OR 0.55; 95% CI 0.35-0.89; and p = 0.014), less operative time (MD -8.6 min; 95% CI -14.5 to -2.8; and p < 0.01), lower postoperative pain on day one (MD -1.3 VAS score; 95% CI -2.3 to -0.3; p < 0.01) or chronic pain (OR 0.32; 95% CI 0.12-0.88; and p = 0.028), and faster return-to-work activities (MD -2.1 days; 95% CI -3.7 to -0.6; and p < 0.01). The recurrence rate was 1.4% for Desarda versus 2.1% for Lichtenstein, with no statistical difference between techniques.
In this meta-analysis, Desarda significantly decreases seroma operative time, postoperative pain on day 1, chronic pain, and return-to-work activities.
对于成人开放式腹股沟疝修补术，Lichtenstein 技术是使用网片的金标准。Desarda 技术于 2001 年问世，作为一种新颖的、有前途的无网技术，已证明复发率和术后并发症较低。
我们检索了 MEDLINE、Cochrane 临床试验中央注册库和 Embase，以获取截至 2024 年 4 月发表的随机对照试验 (RCT)。使用随机效应模型汇总优势比 (OR) 及其 95%置信区间 (CI)。使用 Cochran's Q 检验和 I 统计量评估异质性，p 值<0.10 和 I>25% 被认为具有统计学意义。使用 R 软件（版本 4.1.2）进行统计分析。
纳入了 18 项 RCT，共 1756 名患者，其中 861 名（49%）接受了 Desarda 手术，895 名（51%）接受了 Lichtenstein 手术。与 Lichtenstein 相比，Desarda 术式的血清肿发生率较低（OR 0.55；95%CI 0.35-0.89；p=0.014），手术时间较短（MD-8.6 分钟；95%CI-14.5 至-2.8；p<0.01），术后第 1 天疼痛较轻（MD-1.3 视觉模拟评分；95%CI-2.3 至-0.3；p<0.01）或慢性疼痛（OR 0.32；95%CI 0.12-0.88；p=0.028），并且更快地恢复工作活动（MD-2.1 天；95%CI-3.7 至-0.6；p<0.01）。Desarda 组的复发率为 1.4%，Lichtenstein 组为 2.1%，两种技术之间无统计学差异。
在这项荟萃分析中，Desarda 显著降低了血清肿手术时间、术后第 1 天疼痛、慢性疼痛和恢复工作活动的时间。
