■在微创腹侧疝修补术(VHR)期间,尚不清楚筋膜缺损是否闭合,与桥接修复(当前护理)相反,对患者有益。我们试图系统地回顾有关微创VHR中筋膜缺损闭合作用的已发表文献。
■PubMed,Embase,Scopus,科克伦,和Clinicaltrials.gov进行了随机对照试验(RCTs)的审查,比较筋膜缺损闭合与桥接修复。主要结局是定义为深部/器官间隙手术部位感染(SSIs)的主要并发症,重新操作,疝气复发,或死亡。次要结果包括SSI,血清肿,逐出,疝气复发,术后疼痛,和生活质量(QOL)。通过随机效应荟萃分析获得具有95%置信区间的集合风险比。
■在579篇筛选文章中,包括5个RCTs的6个出版物。主要并发症无显著差异(10.6%vs10.4%,RR=1.05,95%CI=0.51-2.14,P=.90)或复发(9.0%vs10.6%,组间RR=0.92,95%CI=0.32-2.61,P=.87)。筋膜缺损闭合降低了血清瘤的风险(22.9%vs34.2%,RR=0.60,95%CI=0.37-0.97,P=.04),并可能降低外患风险(6.7%vs9.0%,RR=0.74,95%CI=0.37-1.50,P=.41),以潜在增加SSI风险为代价(3.2%vs1.4%,RR=1.89,95%CI=0.60-5.93;P=.28)。疼痛和QOL评分的报告不一致。
■虽然大多数单独的RCT在微创VHR期间显示出筋膜缺损闭合的益处,我们对筋膜缺损闭合的荟萃分析显示,与桥接修复相比,血清瘤的差异仅有统计学意义.大,需要多中心RCT。
UNASSIGNED: During minimally invasive ventral hernia repair (VHR) it is unknown if a fascial defect closure, as opposed to a bridged repair (current care), is beneficial for patients. We sought to systematically review the published literature on the role of fascial defect closure during minimally invasive VHR.
UNASSIGNED: PubMed, Embase, Scopus, Cochrane, and Clinicaltrials.gov were reviewed for randomized controlled trials (RCTs) that compared fascial defect closure with bridged repair. The primary outcome was major complications defined as deep/organ-space surgical site infections (SSIs), reoperations, hernia recurrences, or deaths. Secondary outcomes included SSI, seroma, eventration, hernia recurrence, post-operative pain, and quality of life (QOL). Pooled risk ratios with 95% confidence intervals were obtained through random effect meta-analyses.
UNASSIGNED: Of 579 screened articles, 6 publications of 5 RCTs were included. No significant difference in major complications (10.6% vs 10.4%, RR=1.05, 95% CI=0.51-2.14, P=.90) or recurrences (9.0% vs 10.6%, RR=0.92, 95% CI=0.32-2.61, P=.87) were found between groups. Fascial defect closure decreased the risk of seromas (22.9% vs 34.2%, RR=0.60, 95% CI=0.37-0.97, P=.04) and may decrease the risk of eventrations (6.7% vs 9.0%, RR=0.74, 95% CI=0.37-1.50, P=.41) at the expense of potentially increasing the risk of SSI (3.2% vs 1.4%, RR=1.89, 95% CI=0.60-5.93; P=.28). Reporting of pain and QOL scores was inconsistent.
UNASSIGNED: While most individual RCTs demonstrated benefit with fascial defect closure during minimally invasive VHR, our meta-analysis of fascial defect closure demonstrated only a statistically significant difference in seromas compared to bridged repair. Large, multi-center RCTs are needed.