背景:脐疝和上腹部疝是最常见的腹壁疝;然而,他们的治疗缺乏标准化。
目的:为了澄清关于治疗可能性的争议,适应症,脐部和腹壁疝修补术的外科技术。
方法:对最近20年发表的随机临床试验进行系统回顾和定性分析,涉及患有脐疝和/或上腹部疝的成年人(18岁及以上),是通过系统地搜索PubMed/Medline进行的,科克伦,SciELO,和LILACS数据库。使用Cochrane偏差风险工具评估个体研究中的偏差风险。
结果:最初,选择了492项研究,随后,选择了15项符合纳入标准的随机对照临床试验,并进行了全面阅读和定性分析,考虑到可能的偏见。
结论:本综述的结论是,使用网状物修复大于1厘米的上腹部/原发性脐疝具有明显的优越性,即使在某些紧急情况下。然而,对于缺损小于1厘米的患者,缝合修复是一个很好的选择。在腹腔镜手术中,最近的证据表明,用纤维蛋白密封剂固定可能具有优势,并建议闭合筋膜缺损。此外,由于缺乏低偏倚风险的随机对照试验,需要对类型进行进一步研究,定位和固定技术,以及电视辅助腹腔镜手术在疝矫正中的真正作用,尤其是脐带。
BACKGROUND: Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment.
OBJECTIVE: To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair.
METHODS: A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool.
RESULTS: Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias.
CONCLUSIONS: This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.