Le Khang Duy Ricky, Lee Su Jin, Shakerian Rose, Loveday Benjamin P T, Read David
Trauma Service, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia.
Department of Surgery, The University of Melbourne, Parkville, Melbourne, Victoria, Australia.
ANZ J Surg. 2025 Sep;95(9):1694-1717. doi: 10.1111/ans.70265. Epub 2025 Jul 25.
Traumatic abdominal wall hernia (TAWH) refers to the disruption of the muscular layers of the abdominal wall following blunt traumatic injury. There is a lack of consensus in the management of TAWH, particularly when trauma laparotomy for concurrent visceral injury is required. This systematic review and meta-analysis aims to evaluate recurrence outcomes with repair technique (mesh vs. direct suture repair) and timing of repair (acute vs. elective) with and without trauma laparotomy.
A comprehensive search was conducted on Medline, Embase, and Cochrane central databases. Keywords related to traumatic abdominal wall hernia, acute and elective treatment, and timing of repair were used to identify relevant articles.
A total of 26 studies involving 432 patients were included. There was reduced recurrence with mesh compared to direct suture repair in patients with TAWH who did not require trauma laparotomy (OR 0.20, 95% CI 0.05-0.82, p = 0.02), although there was no difference in recurrence between acute versus elective repair in this cohort. There was no difference between mesh and direct suture repair for the management of TAWH in patients requiring trauma laparotomy.
This systematic review and meta-analysis identified evidence of reduced recurrence with mesh compared to direct suture repair for a patient with TAWH who did not require trauma laparotomy. There was insufficient evidence of superiority for mesh compared to direct suture repair in trauma laparotomy settings, nor timing of repair in non-trauma laparotomy settings. The strength of the conclusions is limited by the risk of bias in included studies and their heterogeneity.
创伤性腹壁疝（TAWH）是指钝性创伤后腹壁肌肉层的中断。在TAWH的治疗方面缺乏共识，尤其是在需要同时进行创伤性剖腹手术以处理并发的内脏损伤时。本系统评价和荟萃分析旨在评估采用修补技术（补片修补与直接缝合修补）和修补时机（急诊与择期）且有无创伤性剖腹手术情况下的复发结局。
对Medline、Embase和Cochrane中心数据库进行了全面检索。使用与创伤性腹壁疝、急诊和择期治疗以及修补时机相关的关键词来识别相关文章。
共纳入26项研究，涉及432例患者。对于不需要进行创伤性剖腹手术的TAWH患者，与直接缝合修补相比，补片修补可降低复发率（OR 0.20，95%CI 0.05 - 0.82，p = 0.02），尽管该队列中急诊修补与择期修补的复发率无差异。对于需要进行创伤性剖腹手术的TAWH患者，补片修补与直接缝合修补在治疗效果上无差异。
本系统评价和荟萃分析发现，对于不需要进行创伤性剖腹手术的TAWH患者，与直接缝合修补相比，补片修补有降低复发率的证据。在创伤性剖腹手术情况下，与直接缝合修补相比，补片修补无足够证据显示其优越性，在非创伤性剖腹手术情况下，修补时机也无足够证据显示其优越性。结论的力度受到纳入研究的偏倚风险及其异质性的限制。
