Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Caio Mendonça Magalhães, Eric Pasqualotto, William Silva Barbosa, Sergio Mazzola Poli de Figueiredo
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Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary endpoints, respectively. Heterogeneity was assessed with I<sup>2</sup> statistics.</p><p><strong>Results: </strong>Thirteen RCTs comprising 2214 patients were included. Of these, 1089 patients (49%) underwent SHD repair and 1125 (51%) patients underwent TAPP repair. The mean BMI was reported in four studies ranging from 23 to 25.7 kg/m<sup>2</sup>. Data regarding hernia sizes were not available. Compared with TAPP, SHD significantly reduced seroma (RR 0.20; 95% CI 0.04-0.90; p = 0.04; and I<sup>2</sup> = 0%) and increased chronic pain (RR 2.13; 95% CI 1.31-3.46; p < 0.01; and I<sup>2</sup> = 0%) and 1-day postoperative pain (MD 2.01; 95% CI 0.72-3.29; p < 0.01; and I<sup>2</sup> = 97%). However, there were no significant differences between the groups in recurrence (RR 0.94; 95% CI 0.66-1.35; p = 0.75; and I<sup>2</sup> = 12%), hematoma (RR 1.08; 95% CI 0.80-1.46; p = 0.63; and I<sup>2</sup> = 0%), urinary retention (RR 0.82; 95% CI 0.49-1.36; p = 0.43; and I<sup>2</sup> = 0%), and testicular atrophy (RR 3.28; 95% CI 0.79-13.54; p = 0.10; and I<sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>SHD repair demonstrated a lower occurrence of seromas; however, it was associated with a higher occurrence of both acute and chronic postoperative pain compared to TAPP in patients with a normal BMI. No significant differences were observed between the two techniques in terms of hernia recurrence, hematoma formation, urinary retention, or testicular atrophy rates.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"859-867"},"PeriodicalIF":2.3000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Shouldice Versus TAPP for Inguinal Hernia Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Lucas Monteiro Delgado, Bernardo Fontel Pompeu, Caio Mendonça Magalhães, Eric Pasqualotto, William Silva Barbosa, Sergio Mazzola Poli de Figueiredo\",\"doi\":\"10.1002/wjs.12514\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Inguinal hernia (IH) repair is one of the most common surgical procedures worldwide. Among the various techniques available, the Shouldice (SHD) technique is mainly used for nonmesh open repair whereas, the transabdominal preperitoneal (TAPP) approach is a commonly performed minimally invasive method. Despite its widespread use, a direct comparison between the two techniques is lacking. Therefore, this study aims to evaluate the short and long-term outcomes of SHD and TAPP for elective IH repair.</p><p><strong>Methods: </strong>We searched the PubMed, Embase, and Cochrane Library on April 16. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary endpoints, respectively. Heterogeneity was assessed with I<sup>2</sup> statistics.</p><p><strong>Results: </strong>Thirteen RCTs comprising 2214 patients were included. Of these, 1089 patients (49%) underwent SHD repair and 1125 (51%) patients underwent TAPP repair. The mean BMI was reported in four studies ranging from 23 to 25.7 kg/m<sup>2</sup>. Data regarding hernia sizes were not available. Compared with TAPP, SHD significantly reduced seroma (RR 0.20; 95% CI 0.04-0.90; p = 0.04; and I<sup>2</sup> = 0%) and increased chronic pain (RR 2.13; 95% CI 1.31-3.46; p < 0.01; and I<sup>2</sup> = 0%) and 1-day postoperative pain (MD 2.01; 95% CI 0.72-3.29; p < 0.01; and I<sup>2</sup> = 97%). However, there were no significant differences between the groups in recurrence (RR 0.94; 95% CI 0.66-1.35; p = 0.75; and I<sup>2</sup> = 12%), hematoma (RR 1.08; 95% CI 0.80-1.46; p = 0.63; and I<sup>2</sup> = 0%), urinary retention (RR 0.82; 95% CI 0.49-1.36; p = 0.43; and I<sup>2</sup> = 0%), and testicular atrophy (RR 3.28; 95% CI 0.79-13.54; p = 0.10; and I<sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>SHD repair demonstrated a lower occurrence of seromas; however, it was associated with a higher occurrence of both acute and chronic postoperative pain compared to TAPP in patients with a normal BMI. 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引用次数: 0
摘要
腹股沟疝（IH）修补是世界范围内最常见的外科手术之一。在各种可用的技术中，Shouldice （SHD）技术主要用于非网状开放式修复，而经腹腹膜前（TAPP）入路是一种常用的微创方法。尽管这两种技术被广泛使用，但缺乏对其进行直接比较。因此，本研究旨在评估SHD和TAPP用于选择性IH修复的短期和长期结果。方法：我们于4月16日检索PubMed、Embase和Cochrane图书馆。分别对连续终点和二元终点进行95%置信区间（ci）的平均差异（MDs）和风险比（rr）汇总。采用I2统计量评估异质性。结果：纳入13项随机对照试验，共2214例患者。其中，1089例（49%）患者接受了SHD修复，1125例（51%）患者接受了TAPP修复。四项研究报告的平均BMI在23至25.7 kg/m2之间。没有关于疝大小的数据。与TAPP相比，SHD显著降低血清血肿(RR 0.20；95% ci 0.04-0.90；p = 0.04；I2 = 0%)和慢性疼痛加重(RR 2.13；95% ci 1.31-3.46；p 2 = 0%)和术后1天疼痛(MD 2.01；95% ci 0.72-3.29；p 2 = 97%)。但两组间复发率差异无统计学意义(RR 0.94；95% ci 0.66-1.35；p = 0.75；I2 = 12%)、血肿(RR 1.08；95% ci 0.80-1.46；p = 0.63；I2 = 0%)、尿潴留(RR 0.82；95% ci 0.49-1.36；p = 0.43；和I2 = 0%)，睾丸萎缩(RR 3.28；95% ci 0.79-13.54；p = 0.10；I2 = 0%)。结论：SHD修复后血清肿发生率较低；然而，与BMI正常的患者相比，TAPP术后急性和慢性疼痛的发生率更高。两种技术在疝气复发、血肿形成、尿潴留或睾丸萎缩率方面没有显著差异。
Shouldice Versus TAPP for Inguinal Hernia Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Introduction: Inguinal hernia (IH) repair is one of the most common surgical procedures worldwide. Among the various techniques available, the Shouldice (SHD) technique is mainly used for nonmesh open repair whereas, the transabdominal preperitoneal (TAPP) approach is a commonly performed minimally invasive method. Despite its widespread use, a direct comparison between the two techniques is lacking. Therefore, this study aims to evaluate the short and long-term outcomes of SHD and TAPP for elective IH repair.
Methods: We searched the PubMed, Embase, and Cochrane Library on April 16. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary endpoints, respectively. Heterogeneity was assessed with I2 statistics.
Results: Thirteen RCTs comprising 2214 patients were included. Of these, 1089 patients (49%) underwent SHD repair and 1125 (51%) patients underwent TAPP repair. The mean BMI was reported in four studies ranging from 23 to 25.7 kg/m2. Data regarding hernia sizes were not available. Compared with TAPP, SHD significantly reduced seroma (RR 0.20; 95% CI 0.04-0.90; p = 0.04; and I2 = 0%) and increased chronic pain (RR 2.13; 95% CI 1.31-3.46; p < 0.01; and I2 = 0%) and 1-day postoperative pain (MD 2.01; 95% CI 0.72-3.29; p < 0.01; and I2 = 97%). However, there were no significant differences between the groups in recurrence (RR 0.94; 95% CI 0.66-1.35; p = 0.75; and I2 = 12%), hematoma (RR 1.08; 95% CI 0.80-1.46; p = 0.63; and I2 = 0%), urinary retention (RR 0.82; 95% CI 0.49-1.36; p = 0.43; and I2 = 0%), and testicular atrophy (RR 3.28; 95% CI 0.79-13.54; p = 0.10; and I2 = 0%).
Conclusion: SHD repair demonstrated a lower occurrence of seromas; however, it was associated with a higher occurrence of both acute and chronic postoperative pain compared to TAPP in patients with a normal BMI. No significant differences were observed between the two techniques in terms of hernia recurrence, hematoma formation, urinary retention, or testicular atrophy rates.
期刊介绍：
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.
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