Abstract：
Introduction: Minimally invasive surgery for ventral hernia repair (MIS-VHR) with mesh in retromuscular plane can be performed by either transabdominally (TA-RM) or via enhanced view totally extraperitoneal approach (eTEP). Although both techniques offer the mesh extension in the best anatomical space, closure of hernia defect, avoidance of traumatic fixation, the superiority of one approach over another is not established. This systematic review and meta-analysis were set up to analyze safety and efficacy of eTEP in comparison with TA-RM. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was used as guideline to conduct systematic search of literature. Studies that provided comparative data of MIS-VHR using eTEP versus TA-RM were identified. Primary outcomes were major complications. These were defined as grade III-IV according to Clavien-Dindo classification. Secondary outcomes included: surgical site infection (SSI) rates, seroma rates, surgical site occurrence requiring procedural intervention (SSOPI), minor complications (Clavien-Dindo grade I-II), intraoperative complications, recurrence rate, postoperative ileus, duration of surgery, postoperative pain. Random- and fixed-effects models of statistical analysis were used. Risk difference (RD) was computated for binary outcomes (major and minor complications, SSI, seroma, SSOPI, recurrence, ileus) with 95% confidence intervals. I2 test was used to assess statistical heterogeneity. Risk of bias assessment was performed using Newcastle-Ottawa framework. Results: There were 3 observational studies that enrolled 370 participants. In the eTEP group there were 166 patients and, in the TA-RM group there were 204 patients. There was no significant RD with regard to major complications (RD -0.02 [-0.06 to 0.02], test for overall effect: Z = 0.86 [P = .39]). There was no significant RD in occurrence of minor complications, SSI, seroma, SSOPI, recurrence, ileus. Conclusions: Both eTEP and TA-RM were found to have equal safety profile. Further high-quality studies evaluating patient reported outcomes and late recurrence may be useful. PROSPERO registration number: CRD42023429160.
摘要：
简介：腹侧疝修补术（MIS-VHR）在后肌平面网片可以通过腹内（TA-RM）或通过增强视图完全腹膜外入路（eTEP）进行。尽管这两种技术都在最佳解剖空间中提供了网格扩展，疝缺损闭合,避免创伤性固定，一种方法比另一种方法的优越性还没有确立。本系统评价和荟萃分析旨在分析eTEP与TA-RM的安全性和有效性。材料与方法：采用系统评价和荟萃分析（PRISMA）框架的首选报告项目作为指南进行系统的文献检索。确定了使用eTEP与TA-RM提供MIS-VHR比较数据的研究。主要结果是主要并发症。根据Clavien-Dindo分类，这些定义为III-IV级。次要结果包括：手术部位感染（SSI）率，血清瘤发生率，需要手术干预的手术部位发生(SSOPI)，轻微并发症（Clavien-DindoI-II级），术中并发症,复发率,术后肠梗阻,手术持续时间,术后疼痛。使用统计分析的随机效应和固定效应模型。计算二元结果的风险差异（RD）（主要和次要并发症，SSI,血清肿,SSOPI,复发,肠梗阻)，置信区间为95%。采用I2检验评估统计学异质性。使用纽卡斯尔-渥太华框架进行偏见风险评估。结果：共有3项观察性研究招募了370名参与者。在eTEP组中有166名患者，TA-RM组有204例患者.关于主要并发症，没有明显的RD（RD-0.02[-0.06to0.02]，总体效果检验：Z=0.86[P=.39])。轻微并发症的发生无明显RD，SSI,血清肿,SSOPI,复发,肠梗阻.结论：发现eTEP和TA-RM具有相同的安全性。进一步的高质量研究评估患者报告的结果和晚期复发可能是有用的。PROSPERO注册号：CRD42023429160。
