João Pedro Gonçalves Kasakewitch, Carlos A Balthazar da Silveira, Marina Eguchi Inaba, Raquel Nogueira, Ana Caroline Dias Rasador, Diego L Lima, Flavio Malcher
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Outcomes such as recurrence, complications, seroma, hematoma, SSI, and conversion rates were analyzed, with subgroup analyses conducted for open, TEP, and TAPP procedures.</p><p><strong>Results: </strong>Among 402 screened studies, 18 met the inclusion criteria, covering 8,668 open IHR (64.6%) and 4,761 MIS IHR (35.4%) patients. The rate per 100 events for intraoperative complications was 0.19 (95% CI [0.00; 0.76]; I2 = 71%;), 5.22 per 100 for seroma (95% CI [2.86; 9.34]; I2 = 92%), 0.83 per 100 for SSI (95% CI [0.39; 1.75]; I2 = 48%), 3.16 per 100 for hematoma (95% CI [1.16; 8.31]; I2 = 84%), 3.02 per 100 patients for chronic pain (95% CI [2.53; 3.62]; I2 = 13%), and 0.02 per 100 for recurrence (95% CI [0; 0.16]; I2 = 10%). The conversion rate for MIS was 1.66 per 100 (95% CI [0.89; 3.06]; I2 = 0%). Subgroup analysis revealed no significant difference between TEP and TAPP in intraoperative complications (p = 0.70), but a lower seroma rate in TAPP compared to TEP (5.29 vs. 20 per 100; P = 0.01). MIS had significant reduction in SSI (0.08 vs. 0.34 per 100; P < 0.01), hematoma (1.29 vs. 17.86; p < 0.01), and recurrence (0.08 vs. 0.37; p = 0.04) compared to open, with no difference in seroma rates. 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引用次数: 0
摘要
背景：由于存在疤痕组织和粘连，前列腺切除术后腹股沟疝修补（IHR）患者的微创手术（MIS）一直被认为是一项具有挑战性的手术。我们的目的是通过系统回顾和比例荟萃分析，比较开放式和MIS IHR在前列腺切除术后患者中的结果。材料与方法：检索PubMed/MEDLINE、Embase、Cochrane和Web of Science关于前列腺切除术后开放和MIS IHR的研究。对复发率、并发症、血肿、血肿、SSI和转换率等结果进行分析，并对开放、TEP和TAPP手术进行亚组分析。结果：402项筛选研究中，18项符合纳入标准，涵盖8668例开放式IHR（64.6%）和4761例MIS IHR（35.4%）患者。术中并发症发生率为0.19 / 100 (95% CI [0.00；0.76);I2 = 71%;)，血清瘤为5.22 / 100 (95% CI [2.86；9.34);I2 = 92%)， SSI为0.83 / 100 (95% CI [0.39；1.75);I2 = 48%)，血肿3.16 / 100 (95% CI [1.16；8.31);I2 = 84%)，每100例慢性疼痛患者中有3.02例(95% CI [2.53；3.62);I2 = 13%)，复发率为0.02 / 100 (95% CI [0；0.16);i2 = 10%)。MIS的转换率为1.66 / 100 (95% CI [0.89；3.06);i2 = 0%)。亚组分析显示，TEP和TAPP在术中并发症方面无显著差异（p = 0.70），但TAPP的血清血肿率低于TEP(5.29比20 / 100；p = 0.01)。MIS显著降低了SSI (0.08 vs. 0.34 / 100；结论：在经验丰富的患者中，MIS IHR是前列腺切除术后患者安全有效的选择，与开放式IHR相比，并发症发生率较低，尽管需要高质量的比较研究来建立明确的结论。普洛斯彼罗注册：2024年7月7日（ID CRD42024562863）。
Open and minimally invasive inguinal hernia repair for patients with previous prostatectomy: a systematic review and proportional meta-analysis.
Background: Minimally invasive surgery (MIS) for patients undergoing inguinal hernia repair (IHR) after prostatectomy has been considered a challenging procedure due to the presence of scar tissue and adhesions. We aimed to compare the outcomes of open and MIS IHR outcomes in post-prostatectomy patients through a systematic review and proportional meta-analysis.
Material & methods: PubMed/MEDLINE, Embase, Cochrane, and Web of Science were searched for studies on open and MIS IHR after prostatectomy. Outcomes such as recurrence, complications, seroma, hematoma, SSI, and conversion rates were analyzed, with subgroup analyses conducted for open, TEP, and TAPP procedures.
Results: Among 402 screened studies, 18 met the inclusion criteria, covering 8,668 open IHR (64.6%) and 4,761 MIS IHR (35.4%) patients. The rate per 100 events for intraoperative complications was 0.19 (95% CI [0.00; 0.76]; I2 = 71%;), 5.22 per 100 for seroma (95% CI [2.86; 9.34]; I2 = 92%), 0.83 per 100 for SSI (95% CI [0.39; 1.75]; I2 = 48%), 3.16 per 100 for hematoma (95% CI [1.16; 8.31]; I2 = 84%), 3.02 per 100 patients for chronic pain (95% CI [2.53; 3.62]; I2 = 13%), and 0.02 per 100 for recurrence (95% CI [0; 0.16]; I2 = 10%). The conversion rate for MIS was 1.66 per 100 (95% CI [0.89; 3.06]; I2 = 0%). Subgroup analysis revealed no significant difference between TEP and TAPP in intraoperative complications (p = 0.70), but a lower seroma rate in TAPP compared to TEP (5.29 vs. 20 per 100; P = 0.01). MIS had significant reduction in SSI (0.08 vs. 0.34 per 100; P < 0.01), hematoma (1.29 vs. 17.86; p < 0.01), and recurrence (0.08 vs. 0.37; p = 0.04) compared to open, with no difference in seroma rates. Funnel plots revealed no evidence of publication bias.
Conclusions: In experienced hands, MIS IHR is a safe and effective option for post-prostatectomy patients, with lower complication rates compared to open IHR, although high-quality comparative studies are needed to establish definitive conclusions.
Prospero registration: July 7, 2024 (ID CRD42024562863).
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.
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