PDF(Pubmed)
Abstract：
Various surgical approaches for inguinal hernia repair have been outlined in medical literature. In most cases, these lesions are repaired by general surgeons. A variety of surgical techniques for the treatment of inguinal hernias have been documented in the medical literature. In 2018, the European Hernia Society (EHS) recommended laparo-endoscopic repair as a preferred approach for adults. This method involves a combination of laparoscopic and endoscopic techniques for hernia repair. The goal of this systematic review is to conduct a thorough examination of the total extraperitoneal vs. transabdominal preperitoneal comparison in inguinal hernia repair, with an emphasis on randomized controlled trials (RCTs). It also intends to conduct a trial sequential analysis (TSA) in order to determine whether more trials and investigations are required or whether there is sufficient evidence to draw a firm conclusion. The study\'s systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used the PubMed and Google Scholar databases to conduct a thorough web search for articles published between January 2019 and December 2023. The meta-analysis was carried out using Resource Manager Revman version 5.4.1 (Revman International, Inc., New York City, New York). After a review of the studies was done, ten studies were selected to be used in conducting the systematic review and meta-analysis. The recurrence rate of TEP treatment was found to be slightly lower than transabdominal preperitoneal (TAPP). The two techniques did not differ in terms of postoperative complications; however, TEP had a marginally lower rate of postoperative pain. Further, the study revealed that there was a decreased risk of wound infections, seromas, and hematomas with total extraperitoneal (TEP) as opposed to transabdominal preperitoneal (TAPP). TEP also reduced the amount of recovery time needed. After conducting successful hernia treatments, total extraperitoneal and transabdominal preperitoneal both had low rates of complications and recurrence. Based on the information obtained from the study analysis, this meta-analysis provides evidence for the efficacy of TAPP and TEP techniques in the management of inguinal hernias. Though there was a statistically significant difference while applying both methods in the treatment of hernia (p=0.001), TEPs have been shown to have a lower recurrence rate than TAPPs. Similarly, the TEP method has been revealed to have a slight reduction in postoperative pain compared to transabdominal preperitoneal. However, the two techniques have been shown to have no significant difference in postoperative complications. Further, laparoscopic procedures have proved to be a little bit safer and more effective than open procedures. This has been shown by reduced risk of wound infection, hematoma, seroma, and decreased sensibility while using this method. It accelerated the healing process as well. Thus, depending on the needs of the patients and the experience level of the surgeons responsible for the treatments, inguinal hernias can be repaired using either transabdominal preperitoneal or total extraperitoneal techniques since both treatment techniques have generally minimal chance of complications or recurrence as both have proved to safer method.
摘要：
在医学文献中已经概述了用于腹股沟疝修复的各种手术方法。在大多数情况下,这些病变由普通外科医生修复。在医学文献中已经记录了用于治疗腹股沟疝的各种外科技术。2018年，欧洲疝学会（EHS）建议将腹腔镜内镜修复作为成人的首选方法。此方法涉及腹腔镜和内窥镜技术的结合，用于疝修复。这项系统评价的目的是对腹膜外的总检查进行彻底检查。经腹腹膜前腹股沟疝修补术的比较，重点是随机对照试验（RCT）。它还打算进行试验序贯分析（TSA），以确定是否需要更多的试验和调查，或者是否有足够的证据得出确切的结论。本研究的系统评价和荟萃分析按照系统评价和荟萃分析（PRISMA）指南的首选报告项目进行。我们使用PubMed和GoogleScholar数据库对2019年1月至2023年12月之间发表的文章进行了彻底的网络搜索。荟萃分析使用资源管理器Revman版本5.4.1(RevmanInternational，Inc.,纽约市,纽约）。在对研究进行回顾之后，我们选择了10项研究用于进行系统评价和荟萃分析.TEP治疗的复发率略低于经腹腹膜前（TAPP）。两种技术在术后并发症方面没有区别；但是，TEP的术后疼痛发生率略低。Further,研究表明伤口感染的风险降低，血清学,和完全腹膜外血肿（TEP），而不是经腹腹膜前血肿（TAPP）。TEP还减少了所需的恢复时间。在成功进行疝气治疗后,总腹膜外和经腹腹膜前都有较低的并发症和复发率。根据从研究分析中获得的信息，本荟萃分析为TAPP和TEP技术治疗腹股沟疝的有效性提供了证据.尽管两种方法在治疗疝气时存在统计学上的显着差异（p=0.001），TEP已被证明具有比TAPP更低的复发率。同样，与经腹腹膜前相比，TEP方法显示术后疼痛略有减轻。然而,这两种技术在术后并发症方面没有显着差异。Further,事实证明，腹腔镜手术比开腹手术更安全，更有效。伤口感染的风险降低已经证明了这一点，血肿,血清肿,使用这种方法时，灵敏度降低。它也加速了愈合过程。因此，根据患者的需求和负责治疗的外科医生的经验水平，腹股沟疝可以使用经腹腹膜前或全腹膜外技术进行修复，因为两种治疗技术通常都具有最小的并发症或复发机会，因为两者都被证明是更安全的方法。
