PDF(Pubmed)
Abstract：
OBJECTIVE: The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females.
METHODS: We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively.
RESULTS: Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable.
CONCLUSIONS: In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.
METHODS: We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively.
RESULTS: Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable.
CONCLUSIONS: In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.
摘要：
目的：本研究的目的是进行一项荟萃分析，比较保留或不保留子宫圆韧带（URL）的女性腹腔镜腹股沟疝修补术的短期和长期结果。
方法：我们搜索了几个数据库，包括PubMed、WebofScience,科克伦图书馆,和CNKI数据库。这项荟萃分析包括随机临床试验，关于女性腹腔镜腹股沟疝修补术中URL保留或分割的回顾性比较研究。感兴趣的结果是年龄，BMI,疝气类型,手术类型,操作时间,估计失血量,住院时间,血清肿,伴随损伤,网状感染,复发,子宫脱垂,异物感,慢性疼痛,和怀孕。使用ReviewManagerv5.3和TSA软件进行Meta分析和试验序贯分析。分别。
结果：在192篇可能符合条件的文章中，有1104名参与者的9项研究符合资格标准，并被纳入荟萃分析。年龄差异无统计学意义(MD-6.58,95%CI-13.41~0.24;P=0.06),BMI（MD0.05，95CI-0.31至0.40；P=0.81），失血量（MD-0.04，95％CI-0.75至0.66；P=0.90），住院时间（MD-0.22，95％CI-1.13至0.69；P=0.64），血清肿（OR0.71，95％CI0.41至1.24；P=0.23），伴随损伤（OR0.32，95％CI0.01至8.24；P=0.68），网状物感染(OR0.13，95%CI0.01~2.61；P=0.18)，复发（OR1.13，95％CI0.18至7.25；P=0.90），子宫脱垂（OR0.71，95％CI0.07至6.94；P=0.77），异物感（OR1.95，95％CI0.53至7.23；P=0.32）和慢性疼痛（OR1.0395％CI0.4至2.69；P=0.95）。然而,这项荟萃分析显示,保留组与分割组的手术时间差异有统计学意义(MD6.62,95%CI2.20~11.04;P=0.0003).试验序贯分析表明,在第三次研究中,运行时间的累积Z值跨越了传统边界值和TSA边界值,累积样本量已达到要求的信息大小(RIS)，表明目前的结论是稳定的。
结论：总之，腹腔镜腹股沟疝修补术中保留子宫圆韧带的女性需要较长的手术时间,但是在短期或长期并发症方面没有优势，没有明确的证据表明它是否会导致不孕和子宫脱垂。
方法：我们搜索了几个数据库，包括PubMed、WebofScience,科克伦图书馆,和CNKI数据库。这项荟萃分析包括随机临床试验，关于女性腹腔镜腹股沟疝修补术中URL保留或分割的回顾性比较研究。感兴趣的结果是年龄，BMI,疝气类型,手术类型,操作时间,估计失血量,住院时间,血清肿,伴随损伤,网状感染,复发,子宫脱垂,异物感,慢性疼痛,和怀孕。使用ReviewManagerv5.3和TSA软件进行Meta分析和试验序贯分析。分别。
结果：在192篇可能符合条件的文章中，有1104名参与者的9项研究符合资格标准，并被纳入荟萃分析。年龄差异无统计学意义(MD-6.58,95%CI-13.41~0.24;P=0.06),BMI（MD0.05，95CI-0.31至0.40；P=0.81），失血量（MD-0.04，95％CI-0.75至0.66；P=0.90），住院时间（MD-0.22，95％CI-1.13至0.69；P=0.64），血清肿（OR0.71，95％CI0.41至1.24；P=0.23），伴随损伤（OR0.32，95％CI0.01至8.24；P=0.68），网状物感染(OR0.13，95%CI0.01~2.61；P=0.18)，复发（OR1.13，95％CI0.18至7.25；P=0.90），子宫脱垂（OR0.71，95％CI0.07至6.94；P=0.77），异物感（OR1.95，95％CI0.53至7.23；P=0.32）和慢性疼痛（OR1.0395％CI0.4至2.69；P=0.95）。然而,这项荟萃分析显示,保留组与分割组的手术时间差异有统计学意义(MD6.62,95%CI2.20~11.04;P=0.0003).试验序贯分析表明,在第三次研究中,运行时间的累积Z值跨越了传统边界值和TSA边界值,累积样本量已达到要求的信息大小(RIS)，表明目前的结论是稳定的。
结论：总之，腹腔镜腹股沟疝修补术中保留子宫圆韧带的女性需要较长的手术时间,但是在短期或长期并发症方面没有优势，没有明确的证据表明它是否会导致不孕和子宫脱垂。
