Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae116
Maria Picciochi, Matthew J Lee, Samir Pathak, Jessica Banks, Jack A Helliwell, Stephen J Chapman, Neil Smart, Katy Chalmers, Sian Cousins, Natalie Blencowe
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引用次数: 0

Abstract

Introduction: There is a lack of consensus on the management of inguinal hernia with limited symptoms. To address this issue a systematic review of existing randomized clinical trials (RCTs) was performed to critically appraise all existing data on asymptomatic hernia management, focusing on generalizability.

Methods: A scoping review to identify all RCTs comparing surgical and conservative management of patients with inguinal hernias was undertaken. Medline, Embase, Cochrane and ClinicalTrials.gov databases were searched. Data collected included study characteristics and definitions of population, intervention/comparator, and outcomes; and limitations of each study were also extracted. The quality and generalizability of included RCTs were evaluated using Cochrane's ROB-2 and the PRECIS-2 tool, respectively.

Results: Searches returned 661 papers; 14 full-text papers were assessed and three RCTs were identified. All RCTs included only male patients with a mean age above 55 years. All RCTs included asymptomatic patients and two included those with minimal symptoms. Different definitions for 'minimally symptomatic' were used in RCTs and none provided details of what was meant by conservative treatment. Follow-up periods varied between studies (1, 2, 3 years). All RCTs had an overall high risk of bias. According to PRECIS-2, two RCTs were classified as pragmatic, and one was equally pragmatic and explanatory.

Discussion: This systematic review highlights a high risk of bias but a good generalizability of the findings from the RCTs conducted on minimally symptomatic inguinal hernia patients. To improve the guidelines for the management of this group of patients, more generalizable data are needed.

腹股沟疝气的手术治疗与保守治疗:随机对照试验方法学范围综述。
导言:对于症状有限的腹股沟斜疝的治疗,目前尚缺乏共识。为了解决这一问题,我们对现有的随机临床试验(RCT)进行了系统性回顾,对所有关于无症状疝气治疗的现有数据进行了严格评估,重点关注可推广性:方法:进行了一次范围界定审查,以确定所有对腹股沟疝患者进行手术和保守治疗比较的 RCT。检索了 Medline、Embase、Cochrane 和 ClinicalTrials.gov 数据库。收集的数据包括研究特点和人群、干预/比较者和结果的定义;还提取了每项研究的局限性。使用 Cochrane 的 ROB-2 和 PRECIS-2 工具分别评估了纳入的 RCT 的质量和可推广性:结果:通过检索,共检索到 661 篇论文;对 14 篇论文进行了全文评估,并确定了 3 项研究性临床试验。所有研究性临床试验都只纳入了平均年龄在 55 岁以上的男性患者。所有研究都包括无症状的患者,其中两项研究包括症状轻微的患者。研究中对 "症状轻微 "的定义各不相同,没有一项研究详细说明了保守治疗的含义。不同研究的随访时间各不相同(1 年、2 年、3 年)。所有 RCT 的总体偏倚风险都很高。根据 PRECIS-2,两项研究被归类为实用性研究,一项研究的实用性和解释性相同:讨论:本系统综述强调了针对症状轻微的腹股沟疝患者进行的研究性临床试验的高偏倚风险,但研究结果具有良好的普遍性。要改进这类患者的治疗指南,需要更多可推广的数据。
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
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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