背景:女性与腹股沟疝修补术(GHR)后的不良结局有关,包括慢性疼痛和复发率较高。GHR的大多数研究都是在男性中进行的,从这些研究中推断对女性的建议,尽管女性有着复杂的解剖结构.子宫圆韧带(RLU)与骨盆稳定有关,并在感觉功能中起作用。在GHR期间对RLU进行横切是有争议的,因为它可以使网状物放置更容易,但可以促进泌尿生殖系统并发症和慢性疼痛。由于以前没有荟萃分析比较在微创(MIS)GHR期间保留与横切RLU,我们的目标是进行系统评价和荟萃分析,比较两种方法的手术结局.
方法:CochraneCentral,Embase,和PubMed数据库进行了系统的搜索,以比较MIS腹股沟疝手术中横切与保留RLU的研究。评估的结果是手术时间,出血,手术部位事件,住院,慢性疼痛,感觉异常,复发率,和生殖器脱垂的发生率。使用RevMan5.4.1进行统计分析。用I2统计量评估异质性。该荟萃分析的审查方案在PROSPERO注册(CRD42023467146)。
结果:筛选了1738项研究。总共六项研究,由1131名女性组成,包括在内,其中652例(57.6%)在MIS腹股沟疝修补术中保留了RLU。我们发现慢性疼痛没有统计学差异,感觉异常,复发率,术后并发症。我们发现保存组的手术时间更长(MD6.84分钟;95%CI3.0-10.68;P=0.0005;I2=74%)。
结论:切除RLU可缩短MISGHR期间的手术时间,术后并发症发生率无差异。虽然横切看起来很安全,需要进一步的前瞻性随机研究以及长期随访和患者报告结局,以确定MISGHR期间RLU的最佳管理.
BACKGROUND: Female sex has been associated with worse outcomes after groin hernia repair (GHR), including a higher rate of chronic pain and recurrence. Most of the studies in GHR are performed in males, and the recommendations for females extrapolate from these studies, even though females have anatomy intricacies. The round ligament of the uterus (RLU) is associated with pelvic stabilization and plays a role in sensory function. Transection of the RLU during GHR is controversial as it can allow easier mesh placement but can favor genitourinary complications and chronic pain. As no previous meta-analysis compared preserving versus transecting the RLU during minimally invasive (MIS) GHR, we aim to perform a systematic review and meta-analysis evaluating surgical outcomes comparing the approaches.
METHODS: Cochrane Central, Embase, and PubMed databases were systematically searched for studies comparing transection versus preservation of the RLU in MIS groin hernia surgeries. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, chronic pain, paresthesia, recurrence rates, and genital prolapse rates. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics. A review protocol for this meta-analysis was registered at PROSPERO (CRD 42023467146).
RESULTS: 1738 studies were screened. A total of six studies, comprising 1131 women, were included, of whom 652 (57.6%) had preservation of the RLU during MIS groin hernia repair. We found no statistical difference regarding chronic pain, paresthesia, recurrence rates, and postoperative complications. We found a longer operative time for the preservation group (MD 6.84 min; 95% CI 3.0-10.68; P = 0.0005; I2 = 74%).
CONCLUSIONS: Transecting the RLU reduces the operative time during MIS GHR with no difference regarding postoperative complication rates. Although transection appears safe, further prospective randomized studies with long-term follow-up and patient-reported outcomes are necessary to define the optimal management of RLU during MIS GHR.