腹腔镜经腹腹膜前腹股沟疝修补术中补片非固定与固定的比较：一项随机对照试验的系统评价和荟萃分析

Non-fixation versus fixation of mesh in laparoscopic transabdominal preperitoneal repair of inguinal hernia: A systematic review and meta-analysis of randomized controlled trials.

作者信息

Zhang ChenXin, Li Jia, Suo HaiJin, Bai JianPing

机构信息

Department of General Surgery, The 983rd Hospital of Joint Logistic Support Force of PLA, Tianjin, China.

Department of Gastroenterology, The 983rd Hospital of Joint Logistic Support Force of PLA, Tianjin, China.

出版信息

PLoS One. 2024 Dec 6;19(12):e0314334. doi: 10.1371/journal.pone.0314334. eCollection 2024.

PURPOSE

The impact of non-fixation of mesh in transabdominal preperitoneal (TAPP) inguinal hernia repair has not been fully assessed. The aim of this meta-analysis was to comprehensively compare the clinical outcomes of non-fixation and fixation of mesh in TAPP to determine whether non-fixation could affect the outcomes.

METHODS

PubMed, Embase and CENTRAL were searched for studies on TAPP repair of inguinal hernia and mesh fixation published up to June 2023. The literature search was completed on June 22, 2023. Randomized controlled trials that compared perioperative outcomes between mesh fixation and non-fixation without using self-gripping mesh were included. The primary outcome measures were recurrence and evaluation of postoperative pain, while secondary outcome measures included time to normal activity, infection rate and formation of seroma. Subgroup analyses and sensitivity analysis were also conducted.

RESULTS

Six randomized controlled trials were included, involving 679 patients who underwent TAPP with non-fixation and 964 patients with fixation of mesh. There was no significant difference in recurrence between the two groups (RR: 0.83; 95% CI, 0.29-2.39, P = 0.73). The non-fixation group had less pain than the fixation group at 6 months postoperatively (MD: -0.16; 95% CI, -0.23--0.10, P < 0.0001). Additionally, there was no significant difference in the time to return to normal activity or rates of infection or seroma formation between the two groups (MD: -4.95; 95% CI, -11.36-1.45, P = 0.13; RR: 1.18; 95% CI, 0.39-3.62, P = 0.77; RR: 0.94; 95% CI, 0.63-1.40, P = 0.75).

CONCLUSION

Based on the current evidence, non-fixation without using self-gripping mesh may not affect the efficacy of TAPP. It does not increase recurrence rate and may result in less postoperative pain in inguinal hernia with small hernia defect (less than 3cm).

目的

经腹腹膜前（TAPP）腹股沟疝修补术中补片不固定的影响尚未得到充分评估。本荟萃分析的目的是全面比较TAPP中补片不固定与固定的临床结局，以确定不固定是否会影响结局。

方法

检索PubMed、Embase和CENTRAL数据库，查找截至2023年6月发表的关于腹股沟疝TAPP修补术和补片固定的研究。文献检索于2023年6月22日完成。纳入比较补片固定与不固定围手术期结局且未使用自固定补片的随机对照试验。主要结局指标为复发率和术后疼痛评估，次要结局指标包括恢复正常活动的时间、感染率和血清肿形成情况。还进行了亚组分析和敏感性分析。

结果

纳入6项随机对照试验，涉及679例行TAPP补片不固定的患者和964例行补片固定的患者。两组复发率无显著差异（RR：0.83；95%CI，0.29 - 2.39，P = 0.73）。不固定组术后6个月时疼痛程度低于固定组（MD： - 0.16；95%CI， - 0.23 - - 0.10，P < 0.0001）。此外，两组恢复正常活动的时间、感染率或血清肿形成率无显著差异（MD： - 4.95；95%CI， - 11.36 - 1.45，P = 0.13；RR：1.18；95%CI，0.39 - 3.62，P = 0.77；RR：0.94；95%CI，0.63 - 1.40，P = 0.75）。