Abstract：
OBJECTIVE: Recent guidelines indicate the use of mesh in UHR for defects > 1 cm, as it reduces recurrence, with 10% recurrence rate compared to up to 54.5% with primary closure. However, Nguyen et al. shows that primary closure is still widely performed in UHR, especially for small defects (1-2 cm), for which there is no published data to determine the optimal approach. In addition, previous meta-analysis by Madsen et al. comparing mesh repair with primary closure in UHR didn\'t exclude emergency conditions and recurrent hernias; also, didn\'t report subgroup analysis on hernia defect size. Thus, we aimed to perform a systematic review and meta-analysis comparing the mesh repairs vs. primary closure of the defect in an open elective primary UHR.
METHODS: We searched for studies comparing mesh with suture in open UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs from inception until October 2023. Studies with patients ≤ 18 years old, with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, wound infection, and hospital length of stay. Subgroup analysis was performed for: (1) RCTs only, and (2) hernia defects smaller than 2 cm. We used RevMan 5.4. for statistical analysis. Heterogeneity was assessed with I² statistics, and random effect was used if I² > 25%.
RESULTS: 2895 studies were screened and 56 were reviewed. 12 studies, including 4 RCTs, 1 prospective cohort, and 7 retrospective cohorts were included, comprising 2926 patients in total (47.6% in mesh group and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I2 = 24%) and for hernia defects smaller than 2 cm (RR 0.56; 95% CI 0.34 to 0.93; P = 0.03; I2 = 0%). Suture repair showed lower rates of seroma (RR 1.88; 95% CI 1.07 to 3.32; P = 0.03; I2 = 0%) and wound infection (RR 1.65; 95%CI 1.12 to 2.43; P = 0.01; I2 = 15%) in the overall analysis, with no differences after performing subgroup analysis of RCTs. No differences were seen regarding hematoma and hospital length of stay.
CONCLUSIONS: The use of mesh during UHR is associated with significantly lower incidence of recurrence in a long-term follow-up compared to the suture repair, reinforcing the previous indications of the guidelines. Additionally, despite the overall analysis showing higher risk of seroma and wound infection for the suture repair, no differences were seen after subgroup analysis of RCTs.
BACKGROUND: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024476854).
METHODS: We searched for studies comparing mesh with suture in open UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs from inception until October 2023. Studies with patients ≤ 18 years old, with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, wound infection, and hospital length of stay. Subgroup analysis was performed for: (1) RCTs only, and (2) hernia defects smaller than 2 cm. We used RevMan 5.4. for statistical analysis. Heterogeneity was assessed with I² statistics, and random effect was used if I² > 25%.
RESULTS: 2895 studies were screened and 56 were reviewed. 12 studies, including 4 RCTs, 1 prospective cohort, and 7 retrospective cohorts were included, comprising 2926 patients in total (47.6% in mesh group and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I2 = 24%) and for hernia defects smaller than 2 cm (RR 0.56; 95% CI 0.34 to 0.93; P = 0.03; I2 = 0%). Suture repair showed lower rates of seroma (RR 1.88; 95% CI 1.07 to 3.32; P = 0.03; I2 = 0%) and wound infection (RR 1.65; 95%CI 1.12 to 2.43; P = 0.01; I2 = 15%) in the overall analysis, with no differences after performing subgroup analysis of RCTs. No differences were seen regarding hematoma and hospital length of stay.
CONCLUSIONS: The use of mesh during UHR is associated with significantly lower incidence of recurrence in a long-term follow-up compared to the suture repair, reinforcing the previous indications of the guidelines. Additionally, despite the overall analysis showing higher risk of seroma and wound infection for the suture repair, no differences were seen after subgroup analysis of RCTs.
BACKGROUND: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024476854).
摘要：
目的：最近的指南指出，对于缺陷>1cm的UHR使用网状物，因为它减少了复发，与10％的复发率相比，初次闭合高达54.5％。然而,Nguyen等人。显示主要闭包在UHR中仍然广泛执行，特别是小缺陷（1-2厘米），没有公布的数据来确定最佳方法。此外,Madsen等人之前的荟萃分析。在UHR中比较网片修复和初次闭合并不排除紧急情况和复发性疝；没有报告疝缺损大小的亚组分析。因此，我们的目的是进行系统评价和荟萃分析，比较网孔修复与开放性选择性原发性UHR缺损的主要闭合。
方法：我们在PubMed的开放式UHR中搜索了比较网状物和缝合线的研究，Scopus,科克伦,Scielo,和丁香从成立到2023年10月。对≤18岁患者的研究，排除了复发或紧急情况。结果是复发，血清肿,血肿,伤口感染,和住院时间。进行亚组分析：（1）仅RCT，（2）小于2厘米的疝缺损。我们使用了RevMan5.4。用于统计分析。异质性用I²统计数据评估，如果I²>25%，则使用随机效应。
结果：筛选了2895项研究，回顾了56项研究。12项研究,包括4个随机对照试验,1个前瞻性队列，并纳入了7个回顾性队列，共2926例患者（网状物组47.6%，缝合组为52.4%）。在总体分析（RR0.50;95%CI0.31至0.79;P=0.003;I2=24%）和小于2cm的疝缺损（RR0.56;95%CI0.34至0.93;P=0.03;I2=0%）中显示出较低的复发率。在整体分析中，缝合修复显示血清肿(RR1.88;95%CI1.07至3.32;P=0.03;I2=0%)和伤口感染(RR1.65;95CI1.12至2.43;P=0.01;I2=15%)的发生率较低，进行随机对照试验亚组分析后无差异。血肿和住院时间没有差异。
结论：与缝合修复相比，在UHR期间使用网状物与长期随访中的复发率明显降低相关，加强了以前指南的指示。此外,尽管整体分析显示缝合修复的血清肿和伤口感染的风险更高，RCTs亚组分析后无差异.
背景：本系统综述和荟萃分析的综述方案在PROSPERO（CRD42024476854）注册。
方法：我们在PubMed的开放式UHR中搜索了比较网状物和缝合线的研究，Scopus,科克伦,Scielo,和丁香从成立到2023年10月。对≤18岁患者的研究，排除了复发或紧急情况。结果是复发，血清肿,血肿,伤口感染,和住院时间。进行亚组分析：（1）仅RCT，（2）小于2厘米的疝缺损。我们使用了RevMan5.4。用于统计分析。异质性用I²统计数据评估，如果I²>25%，则使用随机效应。
结果：筛选了2895项研究，回顾了56项研究。12项研究,包括4个随机对照试验,1个前瞻性队列，并纳入了7个回顾性队列，共2926例患者（网状物组47.6%，缝合组为52.4%）。在总体分析（RR0.50;95%CI0.31至0.79;P=0.003;I2=24%）和小于2cm的疝缺损（RR0.56;95%CI0.34至0.93;P=0.03;I2=0%）中显示出较低的复发率。在整体分析中，缝合修复显示血清肿(RR1.88;95%CI1.07至3.32;P=0.03;I2=0%)和伤口感染(RR1.65;95CI1.12至2.43;P=0.01;I2=15%)的发生率较低，进行随机对照试验亚组分析后无差异。血肿和住院时间没有差异。
结论：与缝合修复相比，在UHR期间使用网状物与长期随访中的复发率明显降低相关，加强了以前指南的指示。此外,尽管整体分析显示缝合修复的血清肿和伤口感染的风险更高，RCTs亚组分析后无差异.
背景：本系统综述和荟萃分析的综述方案在PROSPERO（CRD42024476854）注册。
