背景:腹股沟疝的修复是一种常见的外科手术。一些患者在发生异时对侧腹股沟疝(MCIH)后需要进行第二次手术。建议在初次单侧手术的同时加强对侧。在此系统评价中,我们旨在确定有多少患有单侧腹股沟疝的成年患者会发生MCIH。
方法:本综述报告符合PRISMA指南。我们在PubMedPublisher上进行了文献综述,Embase,谷歌学者和Cochrane图书馆至2021年5月,包括报道成人单侧腹股沟疝修补术后MCIH的文章。作为结果衡量标准,登记了诊断为MCIH的患者人数.
结果:共纳入19篇文献,共277,288例患者。荟萃分析后MCIH的综合估计值等于8.3%(95%CI7.1%-9.5%),具有较高的异质性指数(I2=97.9%)。进行随机效应荟萃回归以获得MCIH的百分比作为中位随访时间的函数。MCIH在3年,5年和10年的百分比估计为5.2%,8.0%和17.1%,分别。
结论:我们认为没有足够的临床证据支持所有患者预防性对侧修复。我们在决定进行预防性修复时提出了一种针对患者的方法,考虑到疝气发展的潜在危险因素,手术方法的类型,慢性术后腹股沟疼痛的一般危险因素。需要更多的长期前瞻性数据来指导预防性对侧网状物放置的决定。
BACKGROUND: The repair of inguinal hernias is a common surgical procedure. Some patients will need a second operation after developing a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary unilateral surgery. In this systematic review we aim to determine how many adult patients with a unilateral inguinal hernia will develop a MCIH.
METHODS: This review was reported in line with PRISMA guidelines. We performed a literature review in PubMed Publisher, Embase, Google Scholar and Cochrane Library until May 2021, including articles reporting MCIH after unilateral inguinal hernia repair in adults. As outcome measure, the number of patients diagnosed with a MCIH was registered.
RESULTS: A total of 19 articles with a total of 277,288 patients were included. The combined estimate for MCIH after meta-analysis equaled 8.3% (95% CI 7.1%-9.5%), with a high index of heterogeneity (I2 = 97.9%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated at 5.2%, 8.0% and 17.1%, respectively.
CONCLUSIONS: We suggest that there is insufficient clinical evidence to support prophylactic contralateral repair in all patients. We propose a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors for hernia development, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long-term prospective data are needed to guide the decision for prophylactic contralateral mesh placement.