Abstract：
Persistent postsurgical pain (PPSP) is one of the most bothersome and disabling long-term complications after inguinal hernia repair surgery. Understanding perioperative risk factors that contribute to PPSP can help identify high-risk patients and develop risk-mitigation approaches. The objective of this study was to systematically review and meta-analyze risk factors that contribute to PPSP after inguinal hernia repair. The literature search resulted in 303 papers included in this review, 140 of which were used for meta-analyses. Our results suggest that younger age, female sex, preoperative pain, recurrent hernia, postoperative complications, and postoperative pain are associated with a higher risk of PPSP. Laparoscopic techniques reduce the PPSP occurrence compared to anterior techniques such as Lichtenstein repair, and tissue-suture techniques such as Shouldice repair. The use of fibrin glue for mesh fixation was consistently associated with lower PPSP rates compared to tacks, staples, and sutures. Considerable variability was observed with PPSP assessment and reporting methodology in terms of study design, follow-up timing, clarity of pain definition, as well as pain intensity or interference threshold. High or moderate risk of bias in at least one domain was noted in >75% of studies. These may limit the generalizability of our results. Future studies should assess and report comprehensive preoperative and perioperative risk factors for PPSP adjusted for confounding factors, and develop risk-prediction models to drive stratified PPSP-mitigation trials and personalized clinical decision-making. PERSPECTIVE: This systematic review and meta-analysis summarizes the current evidence on risk factors for persistent pain after inguinal hernia repair. The findings can help identify patients at risk and test personalized risk-mitigation approaches to prevent pain. PROSPERO REGISTRATION: htttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=154663.
摘要：
持续的术后疼痛（PPSP）是腹股沟疝修补术（IHR）手术后最麻烦和致残的长期并发症之一。了解导致PPSP的围手术期风险因素可以帮助识别高危患者并制定风险缓解方法。这项研究的目的是系统回顾和荟萃分析导致IHR后PPSP的危险因素。文献检索产生了这篇综述中的303篇论文，其中140份用于荟萃分析。我们的结果表明，年龄较小，女性性别,术前疼痛,复发性疝,术后并发症和术后疼痛与PPSP的高风险相关.与Lichtenstein修复等前路技术相比，腹腔镜技术可减少PPSP的发生，和组织缝合技术，如Shouldice修复。与大头钉相比，使用纤维蛋白胶进行网状固定始终与较低的PPSP率相关。订书钉,和缝线。在研究设计方面，PPSP评估和报告方法观察到相当大的差异。后续时间安排,疼痛定义的清晰度，以及疼痛强度或干扰阈值。在超过75％的研究中，至少一个领域存在高或中等偏倚风险。这些可能会限制我们结果的普遍性。未来的研究应评估和报告综合的术前和围手术期PPSP的危险因素，校正混杂因素。并开发风险预测模型，以推动分层PPSP缓解试验和个性化临床决策。PROSPERO注册：https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=154663PERSECTIVE：本系统评价和荟萃分析总结了目前关于腹股沟疝修补术后持续性疼痛危险因素的证据。这些发现可以帮助识别有风险的患者，并测试个性化的风险缓解方法来预防疼痛。
