PDF(Pubmed)
Abstract：
BACKGROUND: Ventral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed.
OBJECTIVE: The aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias.
METHODS: A systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work.
RESULTS: Nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32-0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19-0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02-0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19-0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work.
CONCLUSIONS: The results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.
OBJECTIVE: The aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias.
METHODS: A systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work.
RESULTS: Nine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32-0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19-0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02-0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19-0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work.
CONCLUSIONS: The results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.
摘要：
背景：腹壁疝修补术在过去十年中经历了各种发展。腹腔镜原发性腹侧疝修补术可能是开放式修补术的替代方法，因为它可以防止腹部大切口。然而,腹腔镜检查是否能改善临床结局尚未得到系统评估.
目的：目的是比较腹腔镜与开腹手术治疗原发性腹侧疝的临床效果。
方法：对MEDLINE（PubMed）的系统搜索，Scopus,WebofScience,和Cochrane中央控制试验注册于2023年2月进行。纳入了所有比较腹腔镜和开放方法治疗原发性腹侧疝的随机对照试验。对疝气复发的风险比进行了固定效应荟萃分析，局部感染,伤口裂开,和局部血清肿。对术后疼痛进行加权平均差异的荟萃分析，手术持续时间,住院时间,和时间，直到返回工作。
结果：9项研究纳入系统评价和荟萃分析。在腹腔镜检查中，整体疝复发的可能性降低了两倍（RR=0.49；95CI=0.32-0.74；p<0.001；I2=29％）。局部感染（RR=0.30;95CI=0.19-0.49;p<0.001;I2=0%），伤口裂开（RR=0.08;95CI=0.02-0.32;p<0.001;I2=0%），和局部血清肿(RR=0.34;95CI=0.19-0.59;p<0.001;I2=14%)在接受腹腔镜检查的患者中也明显较少。当收集术后疼痛的数据时，获得了严重的异质性，手术持续时间,住院时间,和时间，直到返回工作。
结论：现有研究的结果是有争议的，并且有很高的偏倚风险，小样本量，也没有明确的协议.然而,腹腔镜手术似乎与较低的疝气复发频率相关，局部感染,伤口裂开,和局部血清肿。
目的：目的是比较腹腔镜与开腹手术治疗原发性腹侧疝的临床效果。
方法：对MEDLINE（PubMed）的系统搜索，Scopus,WebofScience,和Cochrane中央控制试验注册于2023年2月进行。纳入了所有比较腹腔镜和开放方法治疗原发性腹侧疝的随机对照试验。对疝气复发的风险比进行了固定效应荟萃分析，局部感染,伤口裂开,和局部血清肿。对术后疼痛进行加权平均差异的荟萃分析，手术持续时间,住院时间,和时间，直到返回工作。
结果：9项研究纳入系统评价和荟萃分析。在腹腔镜检查中，整体疝复发的可能性降低了两倍（RR=0.49；95CI=0.32-0.74；p<0.001；I2=29％）。局部感染（RR=0.30;95CI=0.19-0.49;p<0.001;I2=0%），伤口裂开（RR=0.08;95CI=0.02-0.32;p<0.001;I2=0%），和局部血清肿(RR=0.34;95CI=0.19-0.59;p<0.001;I2=14%)在接受腹腔镜检查的患者中也明显较少。当收集术后疼痛的数据时，获得了严重的异质性，手术持续时间,住院时间,和时间，直到返回工作。
结论：现有研究的结果是有争议的，并且有很高的偏倚风险，小样本量，也没有明确的协议.然而,腹腔镜手术似乎与较低的疝气复发频率相关，局部感染,伤口裂开,和局部血清肿。
