Parastomal Hernia: direct repair versus relocation: is stoma relocation worth the risk? A comparative meta-analysis and systematic review.

IF 2.4 3区 医学 Q2 SURGERY
Ahmed Abdelsamad, Mohammed Khaled Mohammed, Mohamed Badr Almoshantaf, Aya Alrawi, Ziad A Fadl, Ziad Tarek, Nada Osama Aboelmajd, Torsten Herzog, Florian Gebauer, Nada K Abdelsattar, Taha Abd-ElSalam Ashraf Taha
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引用次数: 0

Abstract

Parastomal hernia is a prevalent and challenging complication in patients with stomas, frequently necessitating surgical intervention. The two primary approaches to parastomal hernia repair- direct repair without relocation and stoma relocation- offer distinct benefits and drawbacks. This systematic review and meta-analysis aimed to compare the efficacy and safety of stoma relocation versus direct repair in managing parastomal hernia. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies involving adult patients (≥ 18 years) with parastomal hernia who underwent either stoma relocation or direct repair, with a focus on clinically relevant outcomes. A comprehensive search of Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted up to September 2024. Key short-term outcomes (operative time, surgical site infection, urinary tract infection, bowel obstruction, length of hospital stay, and overall complications) and long-term outcomes (re-admission, recurrence, re-operation, and mortality) were extracted. Statistical analysis included risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Six studies were included, encompassing both laparoscopic and open-surgical techniques. Direct repair was associated with a significantly shorter operative time (MD: 115 min, 95% CI: 95.71 to 134, P < 0.00001) and a reduced length of hospital stay (MD: 2 days, 95% CI: 0.40 to 3.9, P = 0.02). While reoperation rates were significantly lower in the relocation group (RR: 0.15, 95% CI: 0.03 to 0.62, P = 0.009), other outcomes-including recurrence, re-admission, and overall complication rates-showed comparable results between the two approaches. Notably, there were no significant differences in surgical site infection, urinary tract infection, bowel obstruction, or mortality rates. Direct repair may be advantageous for reducing operative time and hospital stay, whereas stoma relocation appears beneficial in reducing reoperation rates. Future research should focus on developing standardized techniques and incorporating patient-specific factors to inform optimal surgical decision-making in parastomal hernia repair.

造口旁疝:直接修复与移位:造口移位值得冒险吗?比较荟萃分析和系统回顾。
造口旁疝是一种常见且具有挑战性的并发症,经常需要手术干预。造口旁疝修复的两种主要方法-直接修复不移位和造口移位-具有明显的优点和缺点。本系统综述和荟萃分析旨在比较造口移位与直接修复治疗造口旁疝的疗效和安全性。遵循PRISMA指南,我们对成年(≥18岁)造口旁疝患者进行了系统回顾和荟萃分析,这些患者接受了造口移位或直接修复,重点关注临床相关结果。对Web of Science、PubMed、Scopus和Cochrane图书馆数据库进行了全面的检索,截止到2024年9月。提取关键的短期结局(手术时间、手术部位感染、尿路感染、肠梗阻、住院时间和总并发症)和长期结局(再入院、复发、再手术和死亡率)。统计分析包括二分类结局的风险比(RR)和连续结局的平均差异(MD)。纳入了六项研究,包括腹腔镜和开放手术技术。直接修复与较短的手术时间相关(MD: 115 min, 95% CI: 95.71 ~ 134, P
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
Updates in Surgery
Updates in Surgery Medicine-Surgery
CiteScore
4.50
自引率
7.70%
发文量
208
期刊介绍: Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.
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