Ali Yasen Mohamedahmed, Mohamed Talaat Issa, Shafquat Zaman, Safeya Mohammed, Marwa Yassin Mohamedahmed, Mohammed Hamid, A K Ali Muhammed, Stephen Odogwu, Syed Adnan Kabir
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The included studies were assessed for risk of bias (RoB) using validated tools appropriate to study design (Cochrane RoB for randomised controlled trials (RCTs), MINORS for non-randomised studies). Our evaluated outcome measures included overall wound complications, surgical site infections (SSI), hematoma and seroma formation, total operative time, length of hospital stay (LOS), and recurrence rate. Data were analysed using RevMan 5.3, employing a random-effects model.</p><p><strong>Results: </strong>A total of eight studies (three RCTs and five observational studies) with 2293 patients (1573 with ACS and 720 with PCSTAR) were included. The PCSTAR group demonstrated a lower rate of overall wound complications (odds ratio [OR] 2.58, P = 0.004) and SSIs (OR 1.72, P = 0.05) compared with the ACS group. No significant differences were observed for hematoma (OR 0.87, P = 0.51) or seroma formation (OR 1.77, P = 0.11), recurrence rate (OR 1.81, P = 0.31), operative time (mean difference [MD] -6.57, P = 0.77), or LOS (MD -0.67, P = 0.16) between the two groups. Overall, RCTs demonstrated a low risk of bias in most domains, whilst non-randomised studies showed moderate methodological quality.</p><p><strong>Conclusion: </strong>Both component separation techniques demonstrated comparable outcomes and efficacy in the repair of large incisional ventral hernias (IVHs). However, PCSTAR seems to be associated with reduced overall wound complications and SSI rates. 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引用次数: 0
摘要
背景：大切口疝（IHs），特别是区域丧失，对修复提出了重大挑战。部件分离，作为一种修复方法，允许足够的覆盖大疝缺陷。我们比较了前假体分离（ACS）与后假体分离联合腹横肌松解（PCSTAR）在修复大IHs中的效果。方法：对各种电子数据库进行系统检索，以确定1990年1月至2025年6月期间发表的比较ACS和PCSTAR用于IH修复的研究。纳入的研究使用适合研究设计的有效工具（随机对照试验的Cochrane RoB，非随机研究的未成年人）评估偏倚风险（RoB）。我们评估的结果包括总体伤口并发症、手术部位感染（SSI）、血肿和血肿形成、总手术时间、住院时间（LOS）和复发率。数据分析采用RevMan 5.3，采用随机效应模型。结果：共纳入8项研究（3项rct和5项观察性研究），共2293例患者（ACS 1573例，PCSTAR 720例）。与ACS组相比，PCSTAR组总体伤口并发症发生率（比值比[OR] 2.58, P = 0.004）和ssi发生率（比值比[OR] 1.72, P = 0.05）较低。两组在血肿（OR 0.87, P = 0.51）、血肿形成（OR 1.77, P = 0.11）、复发率（OR 1.81, P = 0.31）、手术时间（平均差[MD] -6.57, P = 0.77）、LOS （MD -0.67, P = 0.16）方面均无显著差异。总体而言，随机对照试验在大多数领域显示出较低的偏倚风险，而非随机研究显示出中等的方法学质量。结论：两种成分分离技术在修复大切口腹疝（IVHs）方面表现出相当的结果和疗效。然而，PCSTAR似乎与减少整体伤口并发症和SSI发生率有关。少数纳入的随机对照试验表明，需要进一步进行充分的、设计良好的随机对照试验来验证这些发现。
Outcomes of anterior component separation versus posterior component separation with transversus abdominis muscle release for large incisional hernias: a systematic review and meta-analysis.
Background: Large incisional hernias (IHs), especially with loss of domain, pose significant challenges for repair. Component separation, as a method of repair, allows for adequate coverage of large hernial defects. We compared outcomes of anterior component separation (ACS) versus posterior component separation with transversus abdominis muscle release (PCSTAR) in the repair of large IHs.
Methods: A systematic search of various electronic databases was conducted to identify studies (published between January 1990 - June 2025) comparing ACS and PCSTAR performed for IH repair. The included studies were assessed for risk of bias (RoB) using validated tools appropriate to study design (Cochrane RoB for randomised controlled trials (RCTs), MINORS for non-randomised studies). Our evaluated outcome measures included overall wound complications, surgical site infections (SSI), hematoma and seroma formation, total operative time, length of hospital stay (LOS), and recurrence rate. Data were analysed using RevMan 5.3, employing a random-effects model.
Results: A total of eight studies (three RCTs and five observational studies) with 2293 patients (1573 with ACS and 720 with PCSTAR) were included. The PCSTAR group demonstrated a lower rate of overall wound complications (odds ratio [OR] 2.58, P = 0.004) and SSIs (OR 1.72, P = 0.05) compared with the ACS group. No significant differences were observed for hematoma (OR 0.87, P = 0.51) or seroma formation (OR 1.77, P = 0.11), recurrence rate (OR 1.81, P = 0.31), operative time (mean difference [MD] -6.57, P = 0.77), or LOS (MD -0.67, P = 0.16) between the two groups. Overall, RCTs demonstrated a low risk of bias in most domains, whilst non-randomised studies showed moderate methodological quality.
Conclusion: Both component separation techniques demonstrated comparable outcomes and efficacy in the repair of large incisional ventral hernias (IVHs). However, PCSTAR seems to be associated with reduced overall wound complications and SSI rates. A small number of included RCTs mandate that further adequately powered, well-designed RCTs are required to validate these findings.
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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