The impact of non-invasive manual and ultrasonographic reduction for incarcerated obturator hernia: a retrospective cohort study and systematic review.

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2024-10-01 Epub Date: 2024-07-29 DOI:10.1007/s10029-024-03119-4

Fuyumi Kobayashi, Jun Watanabe, Masaru Koizumi, Hironori Yamaguchi, Naohiro Sata

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引用次数: 0

Abstract

Purpose: Non-invasive reduction in patients with incarcerated obturator hernias is an emergency surgery alternative. There are two non-invasive reduction types: manual and ultrasonographic (ultrasound-guided and ultrasound-assisted reduction). However, the impact of ultrasound guidance on manual reduction has not been adequately evaluated. We aimed to compare non-invasive ultrasound reduction with manual reduction in patients with incarcerated obturator hernias.

Methods: We searched MEDLINE, Cochrane Central Library, Embase, Ichushi Web, ClinicalTrial.gov, and ICTRP for relevant studies. The primary outcomes were success and bowel resection rates. We performed a subgroup analysis between ultrasound-guided and ultrasound-assisted reductions. This study was registered in PROSPERO (CRD 42,024,498,295).

Results: We included six studies (112 patients, including 12 from our cohort). The success rate was 78% (69 of 88 cases) with ultrasonographic reduction and 33% (8 of 24 cases) with manual reduction. The success rate was higher with ultrasonographic than with manual reduction. Subgroup analysis revealed no significant difference between ultrasonography-assisted (76%) and ultrasonography-guided (80%) reductions (p = 0.60). Non-invasive reductions were predominantly successful within 72 h of onset, although durations extended up to 216 h in one case. Among the successful reduction cases, emergency surgery and bowel resection were necessary in two cases after 72 h from onset. Bowel resection was required in 48% (12 of 25), where the non-invasive reduction was unsuccessful within 72 h of confirmed onset.

Conclusions: Ultrasonographic reduction can be a primary treatment option for patients with obturator hernias within 72 h of onset by emergency physicians and surgeons on call. Future prospective studies are needed to evaluate ultrasonographic reduction's impact.

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无创人工和超声缩窄术对嵌顿闭孔疝的影响：一项回顾性队列研究和系统性综述。

目的：对于嵌顿性闭孔疝患者，无创缩孔术是一种紧急手术的替代方法。无创缩窄术有两种类型：人工缩窄术和超声引导缩窄术（超声引导缩窄术和超声辅助缩窄术）。然而，超声引导对徒手缩窄术的影响尚未得到充分评估。我们旨在比较无创超声缩窄术和人工缩窄术对嵌顿闭孔疝患者的影响：我们检索了 MEDLINE、Cochrane Central Library、Embase、Ichushi Web、ClinicalTrial.gov 和 ICTRP，以查找相关研究。主要结果是成功率和肠切除率。我们对超声引导和超声辅助肠切除术进行了分组分析。本研究已在 PROSPERO（CRD 42,024,498,295 ）中注册：结果：我们纳入了六项研究（112 名患者，包括我们队列中的 12 名患者）。超声缩窄术的成功率为 78%（88 例中的 69 例），人工缩窄术的成功率为 33%（24 例中的 8 例）。超声缩窄术的成功率高于人工缩窄术。分组分析显示，超声辅助缩窄术（76%）和超声引导缩窄术（80%）之间无明显差异（P = 0.60）。无创减瘤术主要在发病后 72 小时内成功，但有一个病例的持续时间延长至 216 小时。在成功减瘤的病例中，有两例在发病 72 小时后需要进行急诊手术和肠切除术。48%的病例（25 例中的 12 例）需要进行肠切除术，这些病例在确诊发病后 72 小时内进行了无创减容术，但没有成功：结论：对于发病 72 小时内的闭孔疝患者，急诊内科医生和值班外科医生可将超声减张术作为主要治疗方法。今后还需要进行前瞻性研究，以评估超声导引术的效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.