背景:目前的指南指出,Shouldice技术的复发率低于其他缝合修复,因此强烈建议用于非网状腹股沟疝修复。最近,Desarda提出了一种新的组织修复技术,并在针对Lichtenstein技术的试验中进行了研究。
方法:本研究根据PRISMA网络Meta分析声明和AMSTAR2检查表进行。选择网络荟萃分析的方法来评估有关组织修复的随机对照试验,并将Lichtenstein分别与Desarda和Shouldice技术进行比较。以下参数:操作时间,复发,并发症(一般,术中,手术部位发生),术后第1天VAS评分,麻木,慢性疼痛和恢复日常活动。
结果:十四个RCT,涉及2791名患者,符合纳入标准,并入选进行最终分析.锚定间接治疗比较显示,Desarda的技术需要明显更短的手术时间(MD:-12.9分钟;95%CI:-20.6至-5.2),并且恢复更快(MD:-6.6天;95%CI:-11.7至-1.4)。结果涉及术中并发症,术后早期疼痛,血清/血肿,鞘膜积液和感染率,复发,两种技术的麻木和慢性疼痛相似。
结论:如果选择非网状技术,Desarda的疝修补术可以替代Shouldice技术治疗原发性腹股沟疝修补术,因为它的可重复性和更快的术后恢复。我们建议直接比较两种技术进行精心设计的前瞻性研究。
BACKGROUND: Current guidelines state that the
Shouldice technique has lower recurrence rates than other suture repairs and therefore is strongly recommended in non-mesh inguinal hernia repair. Recently a new tissue repair technique has been proposed by Desarda and studied in trials against Lichtenstein technique.
METHODS: The present study was performed according to the PRISMA Statement for Network Meta-analysis and the AMSTAR 2 checklist. The method of network meta-analysis was chosen to evaluate randomized controlled trial published on tissue repair and comparing Lichtenstein respectively with Desarda and
Shouldice techniques. The following parameters: operative time, recurrence, complications (general, intraoperative, Surgical Surgical Site Occurrences), VAS score on postoperative day 1, numbness, chronic pain and return to daily activities.
RESULTS: Fourteen RCTs, involving 2791 patients, fulfilled the inclusion criteria and were selected for final analysis. The anchored indirect treatment comparison showed that Desarda\'s technique requires a significantly shorter operative time (MD: -12.9 min; 95% CI: -20.6 to -5.2) and has a quicker recovery (MD: -6.6 days; 95% CI: -11.7 to -1.4). Outcomes concerning intraoperative complications, early postoperative pain, seroma/hematoma, hydrocele and infection rates, recurrence, numbness and chronic pain were similar among the two techniques.
CONCLUSIONS: Desarda\'s hernia repair can be a valuable alternative to
Shouldice technique for the treatment of primary inguinal hernia repair if a non-mesh technique is chosen, because of its reproducibility and quicker postoperative recovery. We recommend performing well designed prospective studies comparing both techniques directly.