目的:经腹股沟腹膜前(TIPP)技术是一种开放的腹股沟疝修补术,后置网片可降低复发率。然而,经腹腹膜前(TAPP)和完全腹膜外(TEP)技术具有相似的网状定位,具有微创手术(MIS)的优势。因此,我们进行了系统评价和荟萃分析,比较了TIPP和MIS对腹股沟疝修补术的疗效.
方法:Cochrane,Embase,Scopus,Scielo,和PubMed进行了系统搜索,以比较TIPP和MIS技术在腹股沟疝修补术中的研究。评估的结果是复发,慢性疼痛,手术部位感染(SSI),血清肿,还有血肿.我们分别对TAPP和TEP技术进行了亚组分析。用RStudio进行统计学分析。
结果:对81项研究进行了筛选,对19项研究进行了全面回顾。包括六项研究,其中两人将TIPP与TEP技术进行了比较,两个人将TIPP与TAPP进行了比较,两个人将TIPP与TEP和TAPP技术进行了比较。我们发现与TIPP相比,TEP技术的复发率较低(0.38%对1.19%;RR2.68;95%CI1.01至7.11;P=0.04)。此外,在总体分析中,我们发现TIPP组的血清肿发生率较低(RR0.21;P=0.002).我们没有发现总复发的统计学差异(RR1.6;P=0.19),慢性疼痛(RR1.53;P=0.2),SSI(RR2.51;P=0.47),MIS和TIPP之间的血肿(RR1.29;P=0.76)。在TAPP技术的亚组分析中,所有结果均未发现统计学上的显着差异。
结论:我们的系统评价和荟萃分析发现TIPP和MIS方法在复发的总体分析中没有差异,SSI,和慢性疼痛率。需要进一步的研究来分析各个技术,并就此主题得出更准确的结论。
■IDCRD42024530107,2024年4月8日。
OBJECTIVE: The transinguinal preperitoneal (TIPP) technique is an open approach to groin hernia repair with posteriorly positioned mesh supposed to reduce recurrence rates. However, transabdominal preperitoneal (
TAPP) and totally extraperitoneal (TEP) techniques have similar mesh positioning with the advantages of minimally invasive surgery (MIS). Hence, we performed a systematic review and meta-analysis comparing TIPP and MIS for groin hernia repair.
METHODS: Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TIPP and MIS techniques for groin hernia repair. Outcomes assessed were recurrence, chronic pain, surgical site infection (SSI), seroma, and hematoma. We performed a subgroup analysis of
TAPP and TEP techniques separately. Statistical analysis was performed with R Studio.
RESULTS: 81 studies were screened and 19 were thoroughly reviewed. Six studies were included, of which two compared TIPP with TEP technique, two compared TIPP with
TAPP, and two compared TIPP with both TEP and
TAPP techniques. We found lower recurrence rates for the TEP technique compared to TIPP (0.38% versus 1.19%; RR 2.68; 95% CI 1.01 to 7.11; P = 0.04). Also, we found lower seroma rates for TIPP group on the overall analysis (RR 0.21; P = 0.002). We did not find statistically significant differences regarding overall recurrence (RR 1.6; P = 0.19), chronic pain (RR 1.53; P = 0.2), SSI (RR 2.51; P = 0.47), and hematoma (RR 1.29; P = 0.76) between MIS and TIPP. No statistically significant differences were found in the subgroup analysis of
TAPP technique for all the outcomes.
CONCLUSIONS: Our systematic review and meta-analysis found no differences between TIPP and MIS approaches in the overall analysis of recurrence, SSI, and chronic pain rates. Further research is needed to analyze individual techniques and draw a more precise conclusion on this subject.
UNASSIGNED: ID CRD42024530107, April 8, 2024.