Abstract：
Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used. Given the rarity of this disease, large studies are lacking, and data to drive management are still limited. This systematic review and meta-analysis aimed to describe current surgical options for OHs, with a focus on comparing the effectiveness and safety of mesh use with primary repair.
PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4.
One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups.
Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient\'s clinical status, comorbidities, and degree of intraoperative contamination.
PubMed, EMBASE, and Cochrane were searched for studies comparing mesh and non-mesh repair for OH. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4.
One thousand seven hundred and sixty studies were screened and sixty-seven were thoroughly reviewed. We included 13 observational studies with 351 patients surgically treated for OH with mesh or non-mesh repair. One hundred and twenty (34.2%) patients underwent mesh repair and two hundred and thirty-one (65.81%) underwent non-mesh repair. A total of 145 (41.3%) underwent bowel resection, with the majority having a non-mesh repair performed. Hernia recurrence was significantly higher in patients who underwent hernia repair without mesh (RR 0.31; 95% CI 0.11-0.94; p = 0.04). There were no differences in mortality (RR 0.64; 95% CI 0.25-1.62; p = 0.34; I2 = 0%) or complication rates (RR 0.59; 95% CI 0.28-1.25; p = 0.17; I2 = 50%) between both groups.
Mesh repair in OH was associated with lower recurrence rates without an increase in postoperative complications. While mesh in clean cases is more likely to offer benefits, an overall recommendation regarding its use in OH repair cannot be made due to potential bias across studies. Given that many OH patients are frail and present emergently, the decision to use mesh is complex and should consider the patient\'s clinical status, comorbidities, and degree of intraoperative contamination.
摘要：
目的：闭孔疝（OH）是一种罕见的腹壁疝。它通常发生在晚期症状表现的老年女性中，死亡率上升。手术是OH的标准护理，通常使用简单的缝合闭合缺损的剖腹手术。鉴于这种疾病的罕见，缺乏大型研究，和驱动管理的数据仍然有限。这项系统评价和荟萃分析旨在描述目前OHs的手术选择，重点比较网状物使用与初级修复的有效性和安全性。
方法：PubMed，EMBASE,和Cochrane进行了比较网格和非网格修复OH的研究。通过汇总分析和荟萃分析评估术后结果。使用RevMan5.4进行统计分析。
结果：筛选了一千七百六十项研究，并对六十七项进行了全面审查。我们纳入了13项观察性研究，其中351例接受网状或非网状修复手术治疗的OH患者。一百二十名（34.2％）患者进行了网状修复，二百三十一名（65.81％）进行了非网状修复。共有145例(41.3%)接受了肠切除术,其中大多数进行了非网格修复。无网片疝修补术患者的疝复发率明显较高(RR0.31;95%CI0.11-0.94;p=0.04)。两组之间的死亡率（RR0.64;95％CI0.25-1.62;p=0.34;I2=0％）或并发症发生率（RR0.59;95％CI0.28-1.25;p=0.17;I2=50％）没有差异。
结论：OH的网片修复与较低的复发率相关，而术后并发症没有增加。虽然在干净的情况下网状物更有可能提供好处，关于其在OH修复中的使用的总体建议不能被提出,因为研究中存在潜在的偏差.鉴于许多OH患者体弱多病，使用网格的决定是复杂的，应该考虑患者的临床状态，合并症,术中污染程度。
方法：PubMed，EMBASE,和Cochrane进行了比较网格和非网格修复OH的研究。通过汇总分析和荟萃分析评估术后结果。使用RevMan5.4进行统计分析。
结果：筛选了一千七百六十项研究，并对六十七项进行了全面审查。我们纳入了13项观察性研究，其中351例接受网状或非网状修复手术治疗的OH患者。一百二十名（34.2％）患者进行了网状修复，二百三十一名（65.81％）进行了非网状修复。共有145例(41.3%)接受了肠切除术,其中大多数进行了非网格修复。无网片疝修补术患者的疝复发率明显较高(RR0.31;95%CI0.11-0.94;p=0.04)。两组之间的死亡率（RR0.64;95％CI0.25-1.62;p=0.34;I2=0％）或并发症发生率（RR0.59;95％CI0.28-1.25;p=0.17;I2=50％）没有差异。
结论：OH的网片修复与较低的复发率相关，而术后并发症没有增加。虽然在干净的情况下网状物更有可能提供好处，关于其在OH修复中的使用的总体建议不能被提出,因为研究中存在潜在的偏差.鉴于许多OH患者体弱多病，使用网格的决定是复杂的，应该考虑患者的临床状态，合并症,术中污染程度。
