目的:尽管使用腹膜内嵌网技术(sIPOM)在腹腔镜腹侧疝修补术(LVHR)方面取得了进展,复发仍然是常见的术后并发症。本系统评价和荟萃分析的目的是比较腹侧和切口疝修补术中缺损闭合(IPOM-plus)与非闭合的疗效。目的是确定哪种技术在降低复发率和并发症发生率方面产生更好的结果。
方法:在PubMed,WebofScience,科克伦图书馆,Embase,和ClinicalTrials.gov数据库从开始到2022年10月1日,以确定所有在线英文出版物,这些出版物比较了腹腔镜腹侧疝修补术有和没有筋膜闭合的结果。
结果:3项随机对照试验(RCT)和11项队列研究,涉及1585名患者,符合纳入标准。发现IPOM+技术可减少疝的复发(OR=0.51,95%CI[0.35,0.76],p<0.01),血清肿(OR=0.48,95%CI[0.32,0.71],p<0.01),和网格凸出(OR=0.08,95%CI[0.01,0.42],p<0.01)。亚组分析显示体重指数(BMI)(OR=0.43,95%CI[0.29,0.65],p<0.0001),文章类型(OR=0.51,95%CI[0.35,0.76],p=0.0008<0.01),地理位置(OR=0.54,95%CI[0.36,0.82],p=0.004<0.01),随访时间(OR=0.50,95%CI[0.34,0.73],p=0.0004<0.01)对IPOM-plus技术的术后复发有显着影响。
结论:IPOM-plus技术已被证明可以大大减少复发的发生,血清肿,和网格凸出。总的来说,IPOM-plus技术被认为是一种安全有效的方法。然而,为了进一步评估IPOM-plus技术,需要更多具有延长随访期的随机对照研究.
OBJECTIVE: Despite advancements in laparoscopic ventral hernia repair (LVHR) using the intraperitoneal onlay mesh technique (sIPOM), recurrence remains a common postoperative complication. The objective of this systematic
review and meta-analysis is to compare the efficacy of defect closure (IPOM-plus) versus non-closure in ventral and incisional hernia repair. The aim is to determine which technique yields better outcomes in terms of reducing recurrence and complication rates.
METHODS: A comprehensive literature
review was conducted in the PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov databases from their inception until October 1, 2022, to identify all online English publications that compared the outcomes of laparoscopic ventral hernia repair with and without fascia closure.
RESULTS: Three randomized controlled trials (RCTs) and eleven cohort studies involving 1585 patients met the inclusion criteria. The IPOM-plus technique was found to reduce the recurrence of hernias (OR = 0.51, 95% CI [0.35, 0.76], p < 0.01),
seroma (OR = 0.48, 95% CI [0.32, 0.71], p < 0.01), and mesh bulging (OR = 0.08, 95% CI [0.01, 0.42], p < 0.01). Subgroup analysis revealed that body mass index (BMI) (OR = 0.43, 95% CI [0.29, 0.65], p < 0.0001), type of article (OR = 0.51, 95% CI [0.35, 0.76], p = 0.0008 < 0.01), geographical location (OR = 0.54, 95% CI [0.36, 0.82], p = 0.004 < 0.01), follow-up time (OR = 0.50, 95% CI [0.34, 0.73], p = 0.0004 < 0.01) had a significant influence on the postoperative recurrence of the IPOM-plus technique.
CONCLUSIONS: The IPOM-plus technique has been shown to greatly reduce the occurrence of recurrence,
seroma, and mesh bulging. Overall, the IPOM-plus technique is considered a safe and effective procedure. However, additional randomized controlled studies with extended follow-up periods are necessary to further evaluate the IPOM-plus technique.