laparoscopic herniorrhaphy

腹腔镜疝修补术
  • 文章类型: Journal Article
    该分析解决了在腹腔镜疝修补术中与胶网固定(GMF)相比,胶网固定(GMF)的疗效存在不确定性。我们的荟萃分析结合了最近进行的随机对照试验(RCT),以增强评估GMF疗效和安全性的参考。
    PubMedCentral,谷歌学者,科学直接,和Cochrane图书馆广泛审查了从开始到2023年5月使用关键字“胶水网格修复,\"\"钉网孔修复,\"\"腹股沟疝,\"\"疝修补术,\"\"腹腔镜,\"\"网格固定,“和”随机对照试验。\"
    在此荟萃分析中,我们共纳入了20项随机对照试验,使用质量评级单独评估每篇文章。与TMF相比,GMF显示术后第1天慢性疼痛[RR:0.40,(0.23,0.68)]和疼痛评分[MD:-1.07,(-1.90,-0.25)]的发生率显著降低。我们还使用漏斗图和Egger回归来测试发表偏倚。
    总之,这项荟萃分析确定了与TMF相比,GMF在减轻慢性疼痛和术后第1天疼痛方面的意义.然而,关于血肿,GMF和TMF组之间无统计学差异,血清肿,操作时间,复发率,和总并发症。尽管如此,鉴于本研究中的案例数量很少,这些发现必须在未来由多中心验证,大样本,高质量的RCT。
    UNASSIGNED: This analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF.
    UNASSIGNED: PubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords \"Glue mesh repair,\" \"Tack mesh repair,\" \"Inguinal Hernia,\" \"Herniorrhaphy,\" \"Laparoscopic,\" \"Mesh Fixation,\" and \"Randomized controlled trials.\"
    UNASSIGNED: In this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: -1.07, (-1.90, -0.25)]. We also used funnel plots and Egger\'s regression to test for publication bias.
    UNASSIGNED: In summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.
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  • 文章类型: Journal Article
    目的:自从首次描述腹腔镜疝修补术(LH)以来,许多研究比较了LH和开放性疝修补术(OH)的结局,但结果不一致.我们设计了这项研究来评估两种技术之间的结果,因为儿科外科医生对此有足够的信心。方法:我们对最近10年发表的文章进行了系统评价和荟萃分析。结果:包括27篇报告91,653例患者(26,920名LH和64,733名OH)的文章。总手术时间(OT)无显著差异(P=0.07)。亚组分析显示,单侧LH的OT显着缩短(-8.87分钟,P=.03)和双侧疝(-16.86分钟,P=.004),但女性单侧疝的时间更长(+7.47分钟,P=.006)。复发率相似(比值比[OR]1.05,P=0.66)。LH中报告的并发症较少(OR0.51,P=0.03)。对侧阴道未闭平均发生率为39.61%,其闭合报告对侧异时性疝明显减少(OR0.11,P<.00001)。结论:虽然OH仍然被一些作者认为是黄金标准,LH已被证明不仅与OH一样安全,而且还具有其他优势,可以使儿科外科医生在日常实践中而不是仅在某些情况下实施LH。
    Aim: Since the first description of laparoscopic herniorrhaphy (LH), a lot of studies have compared outcomes between LH and open herniorrhaphy (OH) with inconsistent results. We designed this study to assess outcomes between both techniques now that pediatric surgeons have enough confidence with it. Methods: We performed a systematic review and meta-analysis of articles published in the last 10 years. Results: Twenty-seven articles reporting on 91,653 patients (26,920 LH and 64,733 OH) were included. No significant differences were found in overall operative time (OT) (P = .07). Subgroup analysis revealed significantly shorter OT for LH in unilateral (-8.87 minutes, P = .03) and bilateral hernias (-16.86 minutes, P = .004), but longer in unilateral hernias in females (+7.47 minutes, P = .006). Recurrence rate was similar (odds ratio [OR] 1.05, P = .66). Less complications were reported in LH (OR 0.51, P = .03). Contralateral patent processus vaginalis average rate was 39.61% and its closure reported a significant decrease of contralateral metachronous hernia (OR 0.11, P < .00001). Conclusion: Although OH is still considered the gold standard by some authors, LH has proven to be not only as safe as OH but also to have additional advantages that should make pediatric surgeons implement it in their daily practice and not in selected cases alone.
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  • 文章类型: Journal Article
    目的:关于小儿腹股沟疝(PIH)的首选修复技术存在相当多的争论。本系统评价旨在比较腹腔镜疝修补术(LH)和开放疝修补术(OH)在PIH中的疗效和安全性。
    方法:比较LH和OH在没有地区和语言限制的PIH中结局的随机对照试验(RCT)从以下数据库中搜索:PubMed,WebofScience数据库,科克伦图书馆,SciELO引文索引,俄罗斯科学引文索引,中国国家知识基础设施,万方数据与中国科技期刊数据库
    结果:本综述共纳入13项RCTs,涉及1207例患者。LH显示双侧疝修补术的手术时间较短(加权平均差=-8.23,95%置信区间[CI]:-11.22〜-5.23,P<0.00001)。较低的并发症发生率(比值比[OR]=0.32,95%CI:013-0.83,P=0.02)以及较低的伤口感染(OR=0.14,95%CI:0.04-0.55,P=0.005)和主要的男性特异性手术后并发症(OR=0.10,95%CI:0.04-0.24,P<0.00001),对侧腹股沟疝发生率较低(CMIH=0.单侧手术时间无显著差异,完全康复的时间,住院时间,两种技术之间的复发率和鞘膜积液率。
    结论:本综述重申LH和OH技术在PIH修复中具有可比性。然而,在某些方面,在双侧疝的手术时间方面,LH优于OH,术后并发症发生率和CMIH发生率。预计严格设计的RCT可确认LH和OH的临床效果。
    OBJECTIVE: Considerable debates exist regarding the preferable technique to repair a paediatric inguinal hernia (PIH). This systematic review aims to compare the efficacy and safety of laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) in PIH.
    METHODS: The randomised controlled trials (RCTs) that compared the outcomes of LH and OH in PIH without region and language restrictions searched from the following databases: PubMed, Web of Science Database, Cochrane Library, SciELO Citation Index, Russian Science Citation Index, China National Knowledge Infrastructure, WanFang Data and China Science and Technology Journal Database.
    RESULTS: A total of 13 RCTs that involving 1207 patients included in the review. The LH displayed a shorter operative time for bilateral hernia repair (weighted mean difference = -8.23, 95% confidence interval [CI]: -11.22~-5.23, P < 0.00001), a lower complication rate (odds ratio [OR] = 0.32, 95% CI: 013-0.83, P = 0.02) along with a lower wound infection (OR = 0.14, 95% CI: 0.04-0.55, P = 0.005) and major male-specific post-operative complications (OR = 0.10, 95% CI: 0.04-0.24, P < 0.00001) and a less contralateral metachronous inguinal hernia (CMIH) incidence rate (OR = 0.09, 95% CI: 0.02-0.42, P = 0.002). No significant difference was found for unilateral operative time, time to full recovery, length of hospital stay, recurrence and hydrocele rates between the two techniques.
    CONCLUSIONS: The present review reiterates that both the LH and OH techniques for the PIH repair are comparable. However, in some aspects, the LH is superior to the OH in terms of operative time for bilateral hernias, post-operative complications rate and CMIH incidence rate. Rigorously designed RCTs are anticipated to confirm the clinical effects of both LH and OH.
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  • 文章类型: Journal Article
    Hernia repair techniques have evolved recently; however sac handling remains a critical step. Transection of the herniated sac as opposed to total sac reduction may simplify the procedure. However, residual sac tissue may increase the risk for seroma formation. We performed a systemic review and meta-analysis to evaluate the safety and feasibility of transecting the hernia sac during laparoscopic herniorrhaphy. Relevant literature search was performed in PubMed, EMBASE, SCORPUS, and the Cochrane Library databases. Relevant studies that compared total reduction with transection of the herniated sac during laparoscopic herniorrhaphy were included. The primary outcome measure was the incidence of seromas. We also analyzed secondary outcomes including operative duration, postoperative pain scores, complications, and hernia recurrence rate. Of the 330 studies identified, four studies published between 2002 and 2020, with sample sizes ranging from 70 to 520 patients, met the inclusion criteria. Overall, 848 hernias were evaluated. We observed a high incidence of seroma formation in the sac transection group compared to that in the sac reduction group (OR 2.41; 95% CI 1.39 to 4.17, P = 0.002), but the groups did not differ significantly with respect to factor such as operative duration, postoperative complications, and pain score. Herniated sac transection during laparoscopic herniorrhaphy might be associated with a higher risk of seroma formation than that observed with sac reduction. The former approach did not show any significant benefits compared to the latter approach with respect to operative duration and postoperative complications.
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  • 文章类型: Journal Article
    UNASSIGNED: Previous evidence indicated that total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) are advantageous in efficacy of inguinal herniorrhaphy. Therefore, our aim in this study was to evaluate the association of the two laparoscopic approaches on safety of inguinal herniorrhaphy.
    UNASSIGNED: In this update study, we searched the Cochrane Library, EMBASE, PubMed, Scopus, and Web of Science and identified randomized clinical trials comparing complications in TEP and TAPP herniorrhaphy. We mainly used Peto odds ratio with 95% confidence interval (CI) for meta-analysis because of zero-cell.
    UNASSIGNED: Fourteen eligible trials recruited 659 and 682 patients in TEP and TAPP respectively. In overall pooling, although TEP had a higher seroma rate than TAPP (Peto odds ratio =2.01; 95% CI, 1.39 to 2.91), it had a lower scrotal/cord edema rates at immediate postoperative (Peto odds ratio =0.22; 95% CI, 0.09 to 0.57) and 1 week after inguinal hernia repair (Peto odds ratio =0.58; 95% CI, 0.37 to 0.91) than TAPP.
    UNASSIGNED: TEP and TAPP have their own advantages in inguinal herniorrhaphy. TAPP was associated with a lower seroma rate, and TEP was associated with a lower edema rate. Therefore, shared decision-making on laparoscopic inguinal herniorrhaphy with TEP and TAPP is still needed.
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