Khang Duy Ricky Le, Su Jin Lee, Rose Shakerian, Benjamin P T Loveday, David Read
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引用次数: 0
Abstract
Introduction: Traumatic abdominal wall hernia (TAWH) refers to the disruption of the muscular layers of the abdominal wall following blunt traumatic injury. There is a lack of consensus in the management of TAWH, particularly when trauma laparotomy for concurrent visceral injury is required. This systematic review and meta-analysis aims to evaluate recurrence outcomes with repair technique (mesh vs. direct suture repair) and timing of repair (acute vs. elective) with and without trauma laparotomy.
Methodology: A comprehensive search was conducted on Medline, Embase, and Cochrane central databases. Keywords related to traumatic abdominal wall hernia, acute and elective treatment, and timing of repair were used to identify relevant articles.
Results: A total of 26 studies involving 432 patients were included. There was reduced recurrence with mesh compared to direct suture repair in patients with TAWH who did not require trauma laparotomy (OR 0.20, 95% CI 0.05-0.82, p = 0.02), although there was no difference in recurrence between acute versus elective repair in this cohort. There was no difference between mesh and direct suture repair for the management of TAWH in patients requiring trauma laparotomy.
Conclusion: This systematic review and meta-analysis identified evidence of reduced recurrence with mesh compared to direct suture repair for a patient with TAWH who did not require trauma laparotomy. There was insufficient evidence of superiority for mesh compared to direct suture repair in trauma laparotomy settings, nor timing of repair in non-trauma laparotomy settings. The strength of the conclusions is limited by the risk of bias in included studies and their heterogeneity.
简介:外伤性腹壁疝(TAWH)是指钝性创伤后腹壁肌肉层的破坏。对于TAWH的处理缺乏共识,特别是当需要剖腹手术治疗并发内脏损伤时。本系统综述和荟萃分析旨在评估有和无创伤剖腹手术的修复技术(补片与直接缝合修复)和修复时间(急性与选择性)的复发结果。方法:在Medline、Embase和Cochrane中心数据库进行全面检索。采用外伤性腹壁疝相关关键词、急性和选择性治疗、修复时机等进行文献检索。结果:共纳入26项研究,涉及432例患者。在不需要创伤性剖腹手术的TAWH患者中,与直接缝合修复相比,补片的复发率降低(OR 0.20, 95% CI 0.05-0.82, p = 0.02),尽管在该队列中,急性修复与选择性修复的复发率没有差异。在需要开腹手术的患者中,补片和直接缝线修复治疗TAWH没有差异。结论:本系统综述和荟萃分析确定了与直接缝合修复相比,补片减少复发的证据,对于不需要创伤性剖腹手术的TAWH患者。没有足够的证据表明补片在创伤性剖腹手术中比直接缝合修复更优越,也没有证据表明在非创伤性剖腹手术中修补的时机。结论的强度受到纳入研究的偏倚风险及其异质性的限制。
期刊介绍:
ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.