Abstract：
OBJECTIVE: To evaluate the incidence of incisional hernia in patients undergoing direct access to the abdominal cavity in urological surgery.
METHODS: We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed.
RESULTS: The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access.
CONCLUSIONS: The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
METHODS: We conducted a systematic review in Pubmed, Embase, and Cochrane Central from 1980 to the present according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Eighty-four studies were selected for inclusion in this analysis, and meta-analysis and meta-regression were performed.
RESULTS: The total incidence in the 84 studies was 4.8% (95% CI 3.7% - 6.2%) I2 93.84%. Depending on the type of incision, it was higher in the open medial approach: 7.1% (95% CI 4.3%-11.8%) I2 92.45% and lower in laparoscopic surgery: 1.9% (95% CI 1%-3.4%) I2 71, 85% According to access, it was lower in retroperitoneal: 0.9% (95% CI 0.2%-4.8%) I2 76.96% and off-midline: 4.7% (95% CI 3.5%-6.4%) I2 91.59%. Regarding the location of the hernia, parastomal hernias were more frequent: 15.1% (95% CI 9.6% - 23%) I2 77.39%. Meta-regression shows a significant effect in reducing the proportion of hernias in open lateral, laparoscopic and hand-assisted compared to medial open access.
CONCLUSIONS: The present review finds the access through the midline and stomas as the ones with the highest incidence of incisional hernia. The use of the lateral approach or minimally invasive techniques is preferable. More prospective studies are warranted to obtain the real incidence of incisional hernias and evaluate the role of better techniques to close the abdomen.
摘要：
目的：评估泌尿外科手术中直接进入腹腔的患者切口疝的发生率。
方法：我们在Pubmed，Embase,和CochraneCentral从1980年至今，根据系统评价和荟萃分析（PRISMA）声明的首选报告项目。选择了84项研究纳入本分析，进行meta分析和meta回归。
结果：84项研究的总发生率为4.8%（95%CI3.7%-6.2%）I293.84%。根据切口的类型,开放内侧入路较高：7.1％（95％CI4.3％-11.8％）I292.45％，腹腔镜手术较低：1.9％（95％CI1％-3.4％）I271，85％根据通路，在腹膜后：0.9％（95％CI0.2％-4.8％）I276.96％和离线中线：4.7％（95％CI3.5％-6.4％）I291.59％。关于疝气的位置,造口旁疝更常见:15.1%(95%CI9.6%-23%)I277.39%。荟萃回归显示在减少开放外侧疝的比例方面具有显着效果，腹腔镜和手助与内侧开放通道相比。
结论：本综述发现通过中线和气孔进入是切口疝发生率最高的途径。使用侧向入路或微创技术是优选的。有必要进行更多的前瞻性研究，以获得切口疝的真实发生率，并评估更好的闭合腹部技术的作用。
方法：我们在Pubmed，Embase,和CochraneCentral从1980年至今，根据系统评价和荟萃分析（PRISMA）声明的首选报告项目。选择了84项研究纳入本分析，进行meta分析和meta回归。
结果：84项研究的总发生率为4.8%（95%CI3.7%-6.2%）I293.84%。根据切口的类型,开放内侧入路较高：7.1％（95％CI4.3％-11.8％）I292.45％，腹腔镜手术较低：1.9％（95％CI1％-3.4％）I271，85％根据通路，在腹膜后：0.9％（95％CI0.2％-4.8％）I276.96％和离线中线：4.7％（95％CI3.5％-6.4％）I291.59％。关于疝气的位置,造口旁疝更常见:15.1%(95%CI9.6%-23%)I277.39%。荟萃回归显示在减少开放外侧疝的比例方面具有显着效果，腹腔镜和手助与内侧开放通道相比。
结论：本综述发现通过中线和气孔进入是切口疝发生率最高的途径。使用侧向入路或微创技术是优选的。有必要进行更多的前瞻性研究，以获得切口疝的真实发生率，并评估更好的闭合腹部技术的作用。
