背景:腹侧疝修补术(VHR)通常在肥胖患者中进行。虽然膜膜切除术改善了美容效果,它可能会增加并发症,特别是伤口相关的不良事件。尽管它广泛使用,同时膜膜切除术对VHR术后并发症的影响尚不清楚.这项研究旨在评估并发膜膜切除术是否会增加VHR的术后并发症。
方法:我们搜索了PubMed,Scopus,WebofScience,和Cochrane数据库,用于截至2024年4月发表的研究,比较接受VHR的同时行和不同时行脂膜切除术患者的手术结果.我们评估了复发,血清肿,血肿,手术部位感染(SSI),伤口裂开,皮肤坏死,慢性伤口,停留时间(LOS)再入院,手术持续时间,和深静脉血栓栓塞症(DVT)。将风险比(RR)和平均差异(MD)与95%置信区间(CI)合并为二分和连续终点,分别。我们使用RStudio进行统计,异质性用I2统计进行评估。
结果:我们筛选了890项研究,全面回顾了40项研究,包括11项观察性研究和2项随机对照试验,包括23,354名患者。其中,2,972例(13%)患者接受了VHR并同时进行脂膜切除术(VHR-PAN)。平均年龄从37岁到59岁,73%的样本是女性。平均BMI从29到45kg/m2不等,75%的患者接受了网状修复。平均缺损面积为36~389cm2。大多数维修是在底层位置(68%)使用网格(75%)进行的,而24%的维修经历了组件分离。VHR-PAN与复发率降低相关(RR0.74;95%CI0.62至0.89;p<0.001;I2=1%),随访时间为1至36个月。此外,在平均随访至少一年的研究中,复发的亚组分析也显示复发减少(RR0.72;95%CI0.60至0.88;p<0.001;I2=12%),随访时间为12至36个月。此外,同时进行膜膜切除术与SSI增加相关(RR1.31;95%CI1.13~1.51;p<0.001;I2=0%),SSO(RR1.49;95%CI1.26至1.77;p<0.001;I2=11%),皮肤坏死(RR2.94;95%CI1.26至6.85;p=0.012;I2=0%)和再次手术(RR1.73;95%CI1.32至2.28;p<0.001;I2=0%),和更长的LOS(MD0.90天;95CI0.40至1.40;p<0.001;I2=56%)。DVT的发生没有显着差异,肠外瘘,血肿,血清肿,或者伤口裂开,手术时间或再入院率都没有。
结论:VHR-PAN与较低的复发率相关。然而,它增加了伤口发病率和再次手术的风险,并延长了住院时间。外科医生应仔细权衡执行VHR-PAN的风险和收益。
背景:本系统综述和荟萃分析的综述方案在PROSPERO(CRD42024542721)注册。
BACKGROUND: Ventral hernia repair (VHR) is often performed in patients with obesity. While panniculectomy improves cosmetic outcomes, it may increase complications, particularly wound-related adverse events. Despite its widespread use, the impact of concurrent panniculectomy on postoperative complications in VHR remains unclear. This study aimed to assess whether concurrent panniculectomy increases postoperative complications in VHR.
METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane databases for studies published up to April 2024 comparing surgical outcomes in patients undergoing VHR with and without concurrent panniculectomy. We assessed recurrence, seroma, hematoma, surgical site infections (SSI), wound dehiscence, skin necrosis, chronic wound, length of stay (LOS), readmissions, duration of surgery, and deep venous thromboembolism (DVT). Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled for dichotomous and continuous endpoints, respectively. We used RStudio for statistics and heterogeneity was assessed with I2 statistics.
RESULTS: We screened 890 studies, fully reviewed 40, and included 11 observational studies and 2 randomized controlled trials, comprising 23,354 patients. Of these, 2,972 (13%) patients underwent VHR with concurrent panniculectomy (VHR-PAN). The mean age ranged from 37 to 59 years, and 73% of the sample were women. The mean BMI varied from 29 to 45 kg/m2, and 75% of the patients underwent mesh repair. The mean defect area ranged from 36 to 389 cm2. Most repairs were performed using mesh (75%) in an underlay position (68%) and 24% underwent component separation. VHR-PAN was associated with a decrease in recurrence rates (RR 0.74; 95% CI 0.62 to 0.89; p < 0.001; I2 = 1%) with a follow-up ranging from 1 to 36 months. Furthermore, subgroup analysis of recurrence in studies with a mean follow-up of at least one year also showed a reduction in recurrence (RR 0.72; 95% CI 0.60 to 0.88; p < 0.001; I2 = 12%), with a follow-up ranging from 12 to 36 months. Moreover, concurrent panniculectomy was associated with increased SSI (RR 1.31; 95% CI 1.13 to 1.51; p < 0.001; I2 = 0%), SSO (RR 1.49; 95% CI 1.26 to 1.77; p < 0.001; I2 = 11%), skin necrosis (RR 2.94; 95% CI 1.26 to 6.85; p = 0.012; I2 = 0%) and reoperation (RR 1.73; 95% CI 1.32 to 2.28; p < 0.001; I2 = 0%), and longer LOS (MD 0.90 day; 95%CI 0.40 to 1.40; p < 0.001; I2 = 56%). There was no significant difference in ocurrence of DVT, enterocutaneous fistula, hematoma, seroma, or wound dehiscence, neither on operative time or readmission rates.
CONCLUSIONS: VHR-PAN is associated with lower recurrence rates. However, it increases the risk of wound morbidity and reoperation and prolongs hospital stay. Surgeons should carefully weigh the risks and benefits of performing VHR-PAN.
BACKGROUND: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024542721).