Dias Rasador Ana Caroline, Balthazar da Silveira Carlos, Kasakewitch João Pedro, Lech Gabriele, Lima Diego Laurentino, Sreeramoju Prashanth, Malcher Flavio
Bahiana School of Medicine and Public Health, 275 Dom João VI Ave, Salvador, BA, 40290-000, Brazil.
Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brooklin Ave, Boston, MA, 02215, USA.
Surg Endosc. 2024 Dec;38(12):7045-7054. doi: 10.1007/s00464-024-11323-7. Epub 2024 Oct 23.
Minimally invasive inguinal hernia repair has become increasingly accepted, demonstrating superior outcomes over open procedures in postoperative complications. However, certain postoperative complications, such as seroma, remain a dilemma, with many attributing it to the management of the hernia sac. We aimed to perform a systematic review and meta-analysis comparing the reduction versus abandonment of the hernia sac during laparoscopic inguinal hernia repair.
Cochrane, Scopus, SciELO, and PubMed were searched for studies comparing reduction and abandonment of the hernia sac. Our primary outcome was seroma. Secondary outcomes were overall complications, postoperative pain, surgical site infection, recurrence, hospital length of stay (LOS), and operative time. We performed a subgroup analysis of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. Statistical analysis was performed with R Studio.
2388 studies were screened, and seven studies were included, comprising 3153 patients, of which 916 (29%) were in the abandonment group. We found higher seroma rates for the abandonment group (RR 1.52; 95% CI 1.22 to 1.89; P < 0.001). No differences were found in overall complications (RR 0.88; 95% CI 0.55 to 1.42; P = 0.61), postoperative pain (RR 1.15; 95% CI 0.46 to 2.87; P = 0.76), recurrence (RR 2.67; 95% CI 0.51 to 14.05; P = 0.25), operative time (MD - 4.45 min; 95% CI - 12.77 to 3.86; P = 0.29), and LOS (MD -0.06 days; 95% CI - 0.14 to 0.02; P = 0.14) between both groups. Subgroup analysis of seroma showed no differences between the groups when analyzing TAPP (19.3% vs. 13%; RR 1.65; 95% CI 0.91 to 2.99; P = 0.1) and TEP (9% vs. 4.3%; RR 1.69; 95% CI 0.62 to 4.6; P = 0.3) procedures.
Our systematic review and meta-analysis support that hernia sac abandonment may be associated with increased early seroma rates following laparoscopic inguinal hernia repair, but limited data are available for technique-specific analyses.
微创腹股沟疝修补术已越来越被接受，在术后并发症方面显示出优于开放手术的结果。然而，某些术后并发症，如血清肿，仍然是一个难题，许多人将其归因于疝囊的处理。我们旨在进行一项系统评价和荟萃分析，比较腹腔镜腹股沟疝修补术中疝囊回纳与不处理的情况。
检索Cochrane、Scopus、SciELO和PubMed数据库，查找比较疝囊回纳与不处理的研究。我们的主要结局是血清肿。次要结局包括总体并发症、术后疼痛、手术部位感染、复发、住院时间和手术时间。我们对经腹腹膜前（TAPP）和完全腹膜外（TEP）技术进行了亚组分析。使用R Studio进行统计分析。
共筛选了2388项研究，纳入7项研究，共3153例患者，其中916例（29%）在不处理组。我们发现不处理组的血清肿发生率更高（风险比1.52；95%置信区间1.22至1.89；P<0.001）。两组在总体并发症（风险比0.88；95%置信区间0.55至1.42；P=0.61）、术后疼痛（风险比1.15；95%置信区间0.46至2.87；P=0.76））、复发（风险比2.67；95%置信区间0.51至14.05；P=0.25）、手术时间（平均差-4.45分钟；95%置信区间-12.77至3.86；P=0.29）和住院时间（平均差-0.06天；95%置信区间-0.14至0.02；P=0.14）方面未发现差异。血清肿的亚组分析显示，在分析TAPP（19.3%对13%；风险比1.65；95%置信区间0.91至2.99；P=0.1）和TEP（9%对4.3%；风险比1.69；95%置信区间0.62至4.6；P=0.3）手术时，两组之间没有差异。
我们的系统评价和荟萃分析支持以下观点，即腹腔镜腹股沟疝修补术后不处理疝囊可能与早期血清肿发生率增加有关，但针对特定技术分析的数据有限。
