背景:已提出用合成的可再吸收网片加强小腿闭合以降低食管裂孔疝修补术后的复发率,但仍有争议。本系统评价旨在评估安全性,功效,以及使用生物合成网格来增加间隙的中期结果。
方法:在整个系统综述中遵循系统综述和Meta分析指南的首选报告项目。使用非随机干预研究中的偏倚风险和随机试验工具中的偏倚风险对纳入本综述的所有研究进行定性评估。然后总结了以下预定义关键项目的建议:协议,研究问题,搜索策略,研究资格,数据提取,研究设计,偏见的风险,出版偏见,和统计分析。
结果:系统的文献检索发现520篇文章,其中101篇是重复的,355篇文章被确定为与我们的研究无关并被排除。对其余64条的全文进行了全面评估。共有18篇文章(1846例患者)最终纳入了这篇综述,描述使用三种不同的生物合成网格-BIO-A进行食管裂孔疝修复,PhahixST,和polyglactin网。平均手术时间从127到223分钟不等。平均随访时间为12至54个月。没有网状侵蚀或外植体。BIO-A报告了一种与网格相关的狭窄并发症,需要再次手术。研究表明,症状和生活质量评分显着改善,以及对手术的满意度。复发报告为放射学或临床复发。总的来说,复发率从0.9%到25%不等。
结论:使用生物合成网片修复食管裂孔疝是安全有效的,并发症发生率低,症状缓解率高。由于定义和评估复发的显著异质性,报告的复发率差异很大。应进行更大样本和长期随访的进一步随机对照试验,以更好地分析结果和复发率。
Reinforcement of crural closure with synthetic resorbable mesh has been proposed to decrease recurrence rates after hiatal hernia repair, but continues to be controversial. This systematic review aims to evaluate the safety, efficacy, and intermediate-term results of using biosynthetic mesh to augment the hiatus.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed throughout this systematic review. The Risk of Bias in Non-Randomized Studies of Interventions and Risk of Bias in Randomized Trials tools were used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study design, risk of bias, publication bias, and statistical analysis.
The systematic literature search found 520 articles, 101 of which were duplicates and 355 articles were determined to be unrelated to our study and excluded. The full text of the remaining 64 articles was thoroughly assessed. A total of 18 articles (1846 patients) were ultimately included for this review, describing hiatal hernia repair using three different biosynthetic meshes-BIO-A, Phasix ST, and polyglactin mesh. Mean operative time varied from 127 to 223 min. Mean follow up varied from 12 to 54 months. There were no mesh erosions or explants. One mesh-related complication of stenosis requiring reoperation was reported with BIO-A. Studies showed significant improvement in symptom and quality-of-life scores, as well as satisfaction with surgery. Recurrence was reported as radiologic or clinical recurrence. Overall, recurrence rate varied from 0.9 to 25%.
The use of biosynthetic mesh is safe and effective for hiatal hernia repair with low complications rates and high symptom resolution. The reported recurrence rates are highly variable due to significant heterogeneity in defining and evaluating recurrences. Further randomized controlled trials with larger samples and long-term follow-up should be performed to better analyze outcomes and recurrence rates.