目标:鉴于其潜在优势,已提出开放式腹肌释放(oTAR)作为复杂AWR的持久解决方案。然而,它在不同情况下的适用性仍然不确定。我们旨在分析当前可用的证据,并确定手术后的手术结果。
方法:我们在PubMed/Medline中对oTAR进行了系统的电子搜索,Embase,和Cochrane中央对照试验注册数据库。术后发病率和复发率作为主要终点,生活质量(QoL)作为次要终点。使用随机效应模型来生成所有研究之间具有95%置信区间(CI)的合并比例。
结果:共有22项研究纳入了4,910例接受oTAR的患者进行分析。平均疝缺损和网片面积分别为394(140-622)cm2和1065(557-2206)cm2。平均随访时间为19.7(1-32)个月。复发的加权合并比例,总体发病率,手术部位发生(SSO),手术部位感染(SSI),需要手术干预的手术部位(SSOPI),主要发病率和死亡率为:6%(95%CI,3-10%),34%(95%CI,26-43%),22%(95%CI,16-29%),11%(95%CI,8-16%),4%(95%CI,3-7%),6%(95%CI,4-10%)和1%(95%CI,1-2%),分别。在研究中报告了oTAR后QoL的显着改善。
结论:OpenTAR是治疗复杂腹侧疝的有效技术,因为它具有低复发率和QoL的显著改善。然而,观察到的相对较高的发病率强调了进一步选择和优化患者以改善结局的必要性.
OBJECTIVE: Given its potential advantages, open Transversus Abdominis Release (oTAR) has been proposed as a durable solution for complex AWR. However, its applicability in different scenarios remains uncertain. We aimed to analyze the current available evidence and determine surgical outcomes after oTAR.
METHODS: We performed a systematic electronic search on oTAR in PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Postoperative morbidity and recurrence rates were included as primary endpoints and Quality of life (QoL) was included as secondary endpoint. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) between all studies.
RESULTS: A total of 22 studies with 4,910 patients undergoing oTAR were included for analysis. Mean hernia defect and mesh area were 394 (140-622) cm2 and 1065 (557-2206) cm2, respectively. Mean follow-up was 19.7 (1-32) months. The weighted pooled proportion of recurrence, overall morbidity, surgical site occurrences (SSO), surgical site infection (SSI), surgical site occurrences requiring procedural intervention (SSOPI), major morbidity and mortality were: 6% (95% CI, 3-10%), 34% (95% CI, 26-43%), 22% (95% CI, 16-29%), 11% (95% CI, 8-16%), 4% (95% CI, 3-7%), 6% (95% CI, 4-10%) and 1% (95% CI, 1-2%), respectively. A significant improvement in QoL after oTAR was reported among studies.
CONCLUSIONS: Open TAR is an effective technique for complex ventral hernias as it is associated with low recurrence rate and a significant improvement in QoL. However, the relatively high morbidity rates observed emphasize the necessity of further patients\' selection and optimization to improve outcomes.