PDF(Pubmed)
Abstract：
BACKGROUND: The recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). While single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking. This meta-analysis aims to compare the clinical outcomes of HHR and Laparoscopic Hernia Repair (LHR) in the management of IVH.
METHODS: An exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.
RESULTS: The final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.
CONCLUSIONS: The HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.
METHODS: An exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.
RESULTS: The final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.
CONCLUSIONS: The HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.
摘要：
背景：最近开发的混合疝修复技术（HHR），腹腔镜方法的适应，已被提出作为治疗复杂切口腹侧疝（IVH）的潜在替代方法。虽然单臂研究报告了有希望的结果，缺乏确认这些益处的综合荟萃分析。这项荟萃分析旨在比较HHR和腹腔镜疝修补术（LHR）在IVH治疗中的临床结局。
方法：对文献进行了详尽的搜索，针对截至2023年3月31日比较HHR和LHR的中英文出版物。检查的主要结果是手术时间，失血,和肠道损伤。次要结果包括血清肿发生率，伤口感染,术后急性/慢性疼痛，复发,和网格凸出。RevMan5.0软件促进了统计学荟萃分析。
结果：最终分析纳入了来自14项研究的数据，包括总共1158名患者，555例接受HHR，603例接受LHR治疗。后续数据，从12个月到88个月不等，在14项确定的研究中，有12项可用。HHR方法与血清肿风险显著降低相关(OR=0.29,P=0.0004),但伤口感染风险较高(OR=2.10,P=0.04)。两种技术在手术时间上没有观察到显著差异，失血,肠道损伤,肠梗阻,术后疼痛,网格凸出,和复发。
结论：HHR技术在减少手术并发症方面没有明显优势，除了术后血清肿的发生率较低。具有丰富专业知识的外科医生可以选择避免偶然的转换或故意的混合程序。需要进一步的研究来阐明IVH的最佳手术方法。
方法：对文献进行了详尽的搜索，针对截至2023年3月31日比较HHR和LHR的中英文出版物。检查的主要结果是手术时间，失血,和肠道损伤。次要结果包括血清肿发生率，伤口感染,术后急性/慢性疼痛，复发,和网格凸出。RevMan5.0软件促进了统计学荟萃分析。
结果：最终分析纳入了来自14项研究的数据，包括总共1158名患者，555例接受HHR，603例接受LHR治疗。后续数据，从12个月到88个月不等，在14项确定的研究中，有12项可用。HHR方法与血清肿风险显著降低相关(OR=0.29,P=0.0004),但伤口感染风险较高(OR=2.10,P=0.04)。两种技术在手术时间上没有观察到显著差异，失血,肠道损伤,肠梗阻,术后疼痛,网格凸出,和复发。
结论：HHR技术在减少手术并发症方面没有明显优势，除了术后血清肿的发生率较低。具有丰富专业知识的外科医生可以选择避免偶然的转换或故意的混合程序。需要进一步的研究来阐明IVH的最佳手术方法。
