PDF(Pubmed)
Abstract：
Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk.
Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots.
Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair.
Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots.
Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair.
Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
摘要：
目的：腹腔镜疝修补术（LH）已成为许多腹股沟疝（IH）患者中心的首选治疗方法。我们的目的是比较使用腹腔镜全腹膜外（TEP）技术的双侧与单侧IH修复的发病率结果，确定进行双侧IH修复是否会使患者面临额外风险。
方法：到2021年底在PubMed/MEDLINE上发布的手稿，EMBASE,科克伦图书馆,Scopus,搜索了WebofScience。患者（>16岁）接受初级选择性单侧或双侧TEP手术，使用标准的3孔腹腔镜技术，已确定。使用GRADE标准评估证据质量。在可能的情况下进行Meta分析。在这不可能的地方，使用效果方向图进行计票。
结果：8项观察性研究，共纳入18,153例患者.双侧手术的手术时间明显更长。转化为开放没有显著差异，术后血清肿,尿潴留,血肿,和住院时间。双侧IH修补术患者的疝复发率增加。
结论：尽管受纳入研究的观察性质的限制，没有确凿的证据表明单侧和双侧TEPIH修复的发病率存在差异.由于所有包含的论文都仅来自观察性研究，来自所有结果的证据充其量是非常低的质量。因此，该手稿强调了在该领域进行随机对照试验的必要性。
方法：到2021年底在PubMed/MEDLINE上发布的手稿，EMBASE,科克伦图书馆,Scopus,搜索了WebofScience。患者（>16岁）接受初级选择性单侧或双侧TEP手术，使用标准的3孔腹腔镜技术，已确定。使用GRADE标准评估证据质量。在可能的情况下进行Meta分析。在这不可能的地方，使用效果方向图进行计票。
结果：8项观察性研究，共纳入18,153例患者.双侧手术的手术时间明显更长。转化为开放没有显著差异，术后血清肿,尿潴留,血肿,和住院时间。双侧IH修补术患者的疝复发率增加。
结论：尽管受纳入研究的观察性质的限制，没有确凿的证据表明单侧和双侧TEPIH修复的发病率存在差异.由于所有包含的论文都仅来自观察性研究，来自所有结果的证据充其量是非常低的质量。因此，该手稿强调了在该领域进行随机对照试验的必要性。
