PDF(Pubmed)
Abstract：
Introduction: Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias. This study aims to evaluate the efficacy and safety of the combined use of PPP and BTX. Methods: A systematic electronic search was performed according to the PRISMA criteria. A literature search of scientific articles was conducted up to December 2023. Articles were chosen based on the reference to BTX and PPP in loss of domain ventral hernias with a defect width greater than 10 cm before surgery. The GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies. Results: The research yielded seven articles, with 217 patients analysed in total. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days before surgery. PPP complications were reported in 25.6% of patients, The average reduction of the volume of hernia (VH)/volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9%-15%). Only 40 patients (18.4%) required a PCS or TAR to repair the loss of domain hernias. The SSI and SSO rates were 17.5% and 26.2%, respectively. No differences in SSI and SSO rates were found between the different repair techniques. The recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (p < 0.001). Conclusion: BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.
摘要：
简介：术前进行性气腹（PPP）和肉毒杆菌毒素A（BTX）已一起用于领域疝缺失患者的术前准备。本研究旨在评估PPP和BTX联合使用的有效性和安全性。方法：根据PRISMA标准进行系统的电子检索。截至2023年12月，对科学文章进行了文献检索。文章是根据BTX和PPP在手术前缺损宽度大于10cm的腹侧疝丢失中的参考进行选择的。GRADE方法和改良的纽卡斯尔-渥太华量表用于评估研究质量。结果：该研究共发表了7篇文章，总共分析了217名患者。手术前29.5±1.7天进行BTX，手术前14.8±5.8天进行PPP充气。据报道，25.6%的患者出现PPP并发症，疝体积（VH）/腹腔体积（VAC）的平均减少率为7.6％（范围0.9％-15％）。只有40名患者（18.4％）需要PCS或TAR来修复领域疝的损失。SSI和SSO率分别为17.5%和26.2%，分别。在不同的修复技术之间没有发现SSI和SSO率的差异。复发率为5.9%(13/217)。接受IPOM修复的患者的复发明显高于其他技术（p<0.001）。结论：BTX和PPP可能是治疗具有较低SSI和SSO的领域疝损失的有用工具。BTX和PPP的组合减少了更侵入性修复技术的使用。
