Esparham Ali, Shahabi Shahab, Sheikhbahaei Erfan, Safari Shiva, Zefreh Hamidreza
Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram University Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Hernia. 2025 Apr 4;29(1):132. doi: 10.1007/s10029-025-03320-z.
This study compares the outcomes of concurrent metabolic bariatric surgery (MBS) and ventral hernia repair (VHR) vs. staged VHR approach after MBS.
We systematically searched four main databases with relevant keywords. Two independent authors screened and included studies that compared these two approaches. The I² statistic was utilized to evaluate heterogeneity among the studies; if exceeded 50%, a random effects analysis was conducted, while fixed effects analysis was employed for those without severe heterogeneity.
7 studies with 9244 and 11,961 patients in concurrent and staged groups were included, respectively. Our results showed that the rate of mesh infection was significantly higher in concurrent VHR (3.6% vs. 1.9%, OR: 2.18, p < 0.001), and mortality was insignificantly lower in staged VHR (0.3% vs. 0.1%, OR: 1.70, p = 0.09). Although surgical site infection, seroma, bowel obstruction, hernia recurrence, and reoperation were higher in the staged group, comparisons were statistically insignificant (all p > 0.05). Furthermore, hematoma, venous thromboembolic events, and wound dehiscence had nearly the same rates.
Both approaches are viable options, depending on individual patient circumstances (age, BMI, hernia size, hernia-related symptoms, sac with or without intestinal loops) and surgical preferences (type of MBS, with or without mesh, type of mesh) highlighting the importance of individualized surgical planning for optimization of outcomes and minimizing risks in this specific patient population.
The protocol of this study was submitted to PROSPERO and received the registration code CRD42023444310.
本研究比较了同期代谢性减重手术（MBS）与腹疝修补术（VHR）联合进行与MBS术后分期VHR方法的疗效。
我们使用相关关键词系统检索了四个主要数据库。两名独立作者筛选并纳入了比较这两种方法的研究。采用I²统计量评估研究间的异质性；若超过50%，则进行随机效应分析，而对于无严重异质性的研究采用固定效应分析。
分别纳入了7项研究，同期组和分期组的患者分别为9244例和11961例。我们的结果显示，同期VHR的补片感染率显著更高（3.6%对1.9%，OR：2.18，p < 0.001），分期VHR的死亡率略低但无统计学意义（0.3%对0.1%，OR：1.70，p = 0.09）。尽管分期组的手术部位感染、血清肿、肠梗阻、疝复发和再次手术发生率更高，但比较无统计学意义（所有p > 0.05）。此外，血肿、静脉血栓栓塞事件和伤口裂开的发生率几乎相同。
这两种方法都是可行的选择，具体取决于个体患者情况（年龄、体重指数、疝大小、疝相关症状、有无肠管的疝囊）和手术偏好（MBS类型、有无补片、补片类型），突出了个体化手术规划对于优化该特定患者群体的结局和降低风险的重要性。
本研究方案已提交给PROSPERO并获得注册号CRD42023444310。
