PDF(Pubmed)
Abstract：
BACKGROUND: Umbilical hernias, while frequently asymptomatic, may become acutely symptomatic, strangulated or obstructed, and require emergency treatment. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate evidence gaps regarding emergency care of umbilical hernias.
METHODS: EMBASE, MEDLINE and CENTRAL databases were searched using a predefined strategy until November 2023. Primary research studies reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Studies were excluded where emergency umbilical hernia care was not the primary focus and subsets of relevant data were unable to be extracted. Two independent reviewers screened abstracts and full texts, resolving disagreements by consensus or a third reviewer. Data were charted according to core concepts addressed by each study and a narrative synthesis was performed.
RESULTS: Searches generated 534 abstracts, from which 32 full texts were assessed and 14 included in the final review. This encompassed 52 042 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/14), split between single (6/14) and multicentre (8/14) with only one randomized trial. Most multicentre studies were from national databases (7/8). Themes arising included risk assessment (n = 4), timing of surgery (n = 4), investigations (n = 1), repair method (n = 8, four mesh versus suture; four laparoscopic versus open) and operative outcomes (n = 11). The most commonly reported outcomes were mortality (n = 9) and morbidity (n = 7) rates and length of hospital stay (n = 5). No studies included patient-reported outcomes specific to emergency umbilical hernia repair.
CONCLUSIONS: This scoping review demonstrates the paucity of high-quality data for this condition. There is a need for randomized trials addressing all aspects of emergency umbilical hernia repair, with patient-reported outcomes.
METHODS: EMBASE, MEDLINE and CENTRAL databases were searched using a predefined strategy until November 2023. Primary research studies reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Studies were excluded where emergency umbilical hernia care was not the primary focus and subsets of relevant data were unable to be extracted. Two independent reviewers screened abstracts and full texts, resolving disagreements by consensus or a third reviewer. Data were charted according to core concepts addressed by each study and a narrative synthesis was performed.
RESULTS: Searches generated 534 abstracts, from which 32 full texts were assessed and 14 included in the final review. This encompassed 52 042 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/14), split between single (6/14) and multicentre (8/14) with only one randomized trial. Most multicentre studies were from national databases (7/8). Themes arising included risk assessment (n = 4), timing of surgery (n = 4), investigations (n = 1), repair method (n = 8, four mesh versus suture; four laparoscopic versus open) and operative outcomes (n = 11). The most commonly reported outcomes were mortality (n = 9) and morbidity (n = 7) rates and length of hospital stay (n = 5). No studies included patient-reported outcomes specific to emergency umbilical hernia repair.
CONCLUSIONS: This scoping review demonstrates the paucity of high-quality data for this condition. There is a need for randomized trials addressing all aspects of emergency umbilical hernia repair, with patient-reported outcomes.
摘要：
背景：脐疝，虽然经常无症状，可能会出现严重症状，绞死或阻塞，需要紧急治疗。在这一领域的高质量护理需要强有力的证据。本范围审查旨在阐明有关脐疝急诊护理的证据空白。
方法：EMBASE，使用预定义的策略搜索MEDLINE和CENTRAL数据库，直到2023年11月。报告紧急脐疝护理任何方面并以英语发表的主要研究研究有资格纳入。排除了急诊脐疝护理不是主要重点且无法提取相关数据子集的研究。两名独立审稿人筛选了摘要和全文，通过协商一致或第三审稿人解决分歧。根据每个研究解决的核心概念绘制数据，并进行叙事综合。
结果：搜索生成了534个摘要，从中评估了32个全文，并将14个纳入了最终审查。这包括52042名接受紧急脐疝护理的患者。大多数是回顾性队列设计(11/14)，在单中心（6/14）和多中心（8/14）之间进行拆分，只有一项随机试验。大多数多中心研究来自国家数据库（7/8）。产生的主题包括风险评估(n=4)，手术时机（n=4），调查(n=1)，修复方法(n=8，四网与缝合；四例腹腔镜与开放)和手术结果(n=11)。最常见的结果是死亡率（n=9）和发病率（n=7）和住院时间（n=5）。没有研究包括患者报告的特定于紧急脐疝修补术的结果。
结论：这项范围审查表明，这种情况缺乏高质量的数据。需要针对急诊脐疝修补术的各个方面的随机试验，与患者报告的结果。
方法：EMBASE，使用预定义的策略搜索MEDLINE和CENTRAL数据库，直到2023年11月。报告紧急脐疝护理任何方面并以英语发表的主要研究研究有资格纳入。排除了急诊脐疝护理不是主要重点且无法提取相关数据子集的研究。两名独立审稿人筛选了摘要和全文，通过协商一致或第三审稿人解决分歧。根据每个研究解决的核心概念绘制数据，并进行叙事综合。
结果：搜索生成了534个摘要，从中评估了32个全文，并将14个纳入了最终审查。这包括52042名接受紧急脐疝护理的患者。大多数是回顾性队列设计(11/14)，在单中心（6/14）和多中心（8/14）之间进行拆分，只有一项随机试验。大多数多中心研究来自国家数据库（7/8）。产生的主题包括风险评估(n=4)，手术时机（n=4），调查(n=1)，修复方法(n=8，四网与缝合；四例腹腔镜与开放)和手术结果(n=11)。最常见的结果是死亡率（n=9）和发病率（n=7）和住院时间（n=5）。没有研究包括患者报告的特定于紧急脐疝修补术的结果。
结论：这项范围审查表明，这种情况缺乏高质量的数据。需要针对急诊脐疝修补术的各个方面的随机试验，与患者报告的结果。
