目的:个别研究表明吸烟者疝修补术后预后较差。以前的荟萃分析已经检查了吸烟对特定结局的影响,例如复发和手术部位感染。但是在这个问题上缺乏全面的共识或系统的审查。解决这个差距,我们的研究进行了系统评价和荟萃分析,以评估吸烟对腹侧疝修补术(VHR)和腹股沟疝修补术结局的影响.
方法:彻底搜索CochraneCentral,Scopus,SciELO,和PubMed/MEDLINE,重点研究了吸烟对腹股沟和VHR结局的影响.评估的关键结果包括复发,再操作,手术部位发生(SSO),手术部位感染(SSI),和血清肿。
结果:在3296项筛选研究中,42符合纳入标准。其中包括25项关于VHR的研究(69,295例患者)和17项关于腹股沟疝修补术的研究(204,337例患者)。分析显示,吸烟者的复发率明显较高(10.4%vs.9.1%;RR1.48;95%CI[1.15;1.90];P<0.01),SSO(13.6%与12.7%;RR1.44;95%CI[1.12;1.86];P<0.01)和SSI(6.6%vs.VHR后4.2%;RR1.64;95%CI[1.38;1.94];P<0.01)。此外,接受腹股沟疝修补术的吸烟者复发率较高(9%vs.8.7%;RR1.91;95%CI[1.21;3.01];P<0.01),SSI(0.6%与0.3%;RR1.6;95%CI[1.21;2.0];P<0.001),和慢性疼痛(9.9%vs.10%;RR1.24;95%CI[1.06;1.45];P<0.01)率。VHR的血清肿(RR2.63;95%CI[0.88;7.91];P=0.084)和再手术率(RR1.48;95%CI[0.77;2.85];P=0.236)没有显着差异,吸烟者和非吸烟者腹股沟疝的再手术率(RR0.99;95%CI[0.51;1.91];P=0.978)。使用漏斗图和Egger检验的分析显示研究结果中没有发表偏倚。
结论:这项综合荟萃分析发现,复发率有统计学意义的增加,和术后即刻的并发症,如腹股沟和VHR后的SSO和SSI。此外,我们的亚组分析表明,MIS方法似乎对吸烟者组的不良结局具有保护作用.然而,我们的研究结果表明,这些发现与临床无关,因此,我们的数据不支持疝气手术前戒烟的必要性。需要更多的研究来阐明吸烟在腹股沟和腹侧疝修补术中的具体后果。
■IDCRD42024517640。
OBJECTIVE: Individual studies indicate poorer outcomes for smokers after hernia repair. Previous meta-analyses have examined the impact of smoking on specific outcomes such as recurrence and surgical site infection, but there has been a lack of comprehensive consensus or systematic review on this subject. Addressing this gap, our study undertakes a systematic review and meta-analysis to assess the impact of smoking on the outcomes of ventral hernia repair (VHR) and inguinal hernia repair.
METHODS: A thorough search of Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE, focusing on studies that examined the effect of smoking on inguinal and VHR outcomes was conducted. Key outcomes evaluated included recurrence, reoperation, surgical site occurrences (SSO), surgical site infection (SSI), and seroma.
RESULTS: Out of 3296 screened studies, 42 met the inclusion criteria. These comprised 25 studies (69,295 patients) on VHR and 17 studies (204,337 patients) on inguinal hernia repair. The analysis revealed that smokers had significantly higher rates of recurrence (10.4% vs. 9.1%; RR 1.48; 95% CI [1.15; 1.90]; P < 0.01), SSO (13.6% vs. 12.7%; RR 1.44; 95% CI [1.12; 1.86]; P < 0.01) and SSI (6.6% vs. 4.2%; RR 1.64; 95% CI [1.38; 1.94]; P < 0.01) following VHR. Additionally, smokers undergoing inguinal hernia repair showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P < 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P < 0.001), and chronic pain (9.9% vs. 10%; RR 1.24; 95% CI [1.06; 1.45]; P < 0.01) rates. No significant differences were observed in seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084) and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR, and in reoperation rates (RR 0.99; 95% CI [0.51; 1.91]; P = 0.978) for inguinal hernias between smokers and non-smokers. Analysis using funnel plots and Egger\'s test showed the absence of publication bias in the study outcomes.
CONCLUSIONS: This comprehensive meta-analysis found statistically significant increases in recurrence rates, and immediate postoperative complications, such as SSO and SSI following inguinal and VHR. Also, our subgroup analysis suggests that the MIS approach seems to be protective of adverse outcomes in the smokers group. However, our findings suggest that these findings are not of clinical relevance, so our data do not support the necessity of smoking cessation before hernia surgery. More studies are needed to elucidate the specific consequences of smoking in both inguinal and ventral hernia repair.
UNASSIGNED: ID CRD42024517640.