目标:每年,全世界有超过2000万患者接受腹股沟疝修补术。手术是推荐的治疗方法,然而,对最优方法缺乏共识。本研究旨在进行最新的系统评价和荟萃分析,以比较腹腔镜网状修补术(TAPP和TEP)与Lichtenstein修补术治疗腹股沟疝的慢性腹股沟疼痛和复发风险。
方法:在OvidMEDLINE进行搜索,PubMed,EBSCO,科克伦,谷歌学者。纳入标准包括涉及成人的随机对照试验(RCT),以英文和西班牙文出版,比较Lichtenstein开放技术的手术结果,TAPP,和/或TEP。在方法上保持了对PRISMA准则的遵守,并使用CASP工具来评估文章的质量。统计分析涉及平均值[±标准偏差(SD)],赔率比(OR),和置信区间(CI)。
结果:纳入了8个RCT,包括1,469例随机接受Lichtenstein修复(n=755)和腹腔镜内镜修复(n=714)的患者。与Lichtenstein修复相比,腹腔镜内镜修复与慢性腹股沟疼痛的可能性较低相关(OR=0.28,95%CI[0.30-0.56],p=0.0001)。腹腔镜组与Lichtenstein组的复发率无显著差异(OR=1.03,95%CI[0.57-1.86],p=0.92)。
结论:本系统综述和荟萃分析显示,与Lichtenstein修补术相比,腹腔镜内镜疝手术可降低慢性腹股沟疼痛的发生率,同时保持相似的复发率。
OBJECTIVE: Annually, over 20 million patients worldwide undergo inguinal hernia repair procedures. Surgery stands as the recommended treatment, however, a consensus on the optimal method is lacking. This study aims to conduct an updated systematic review and meta-analysis to compare the risk of chronic inguinal pain and recurrence between laparo-endoscopic mesh repair (TAPP and TEP) versus
Lichtenstein repair for inguinal hernia.
METHODS: Searches were conducted in Ovid MEDLINE, PubMed, EBSCO, Cochrane, and Google Scholar. Inclusion criteria encompassed randomized controlled trials (RCTs) involving adults, published in English and Spanish, comparing surgical outcomes among the
Lichtenstein open technique, TAPP, and/or TEP. Adherence to the PRISMA guidelines was maintained in the methodology, and the CASP tool was employed to assess the quality of the articles. Statistical analysis involved mean [± standard deviation (SD)], Odds Ratio (OR), and Confidence Interval (CI).
RESULTS: Eight RCTs encompassing 1,469 patients randomized to
Lichtenstein repair (n = 755) and laparo-endoscopic repair (n = 714) were included. Laparo-endoscopic repair was associated with a lower likelihood of chronic inguinal pain compared to
Lichtenstein repair (OR = 0.28, 95% CI [0.30-0.56], p = 0.0001). There were no significant differences in recurrence rates between the laparo-endoscopic and the
Lichtenstein group (OR = 1.03, 95% CI [0.57-1.86], p = 0.92).
CONCLUSIONS: This systematic review and meta-analysis demonstrate that laparo-endoscopic hernia surgery leads to a lower incidence of chronic inguinal pain compared to Lichtenstein repair, while maintaining similar rates of recurrence.