Maqola

Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-analysis of Randomized Controlled Trials.

Alberto AiolfiDepartment of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, ItalyMarta CavalliDepartment of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, ItalySimona FerraroDepartment of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, ItalyLivia ManfrediniDepartment of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, ItalyLivia ManfrediniDepartment of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan, ItalyGianluca BonittaDepartment of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant’Ambrogio, Milan, ItalyPiero Giovanni BruniDepartment of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milan, ItalyPiero Giovanni BruniDepartment of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, ItalyDavide BonaDepartment of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant’Ambrogio, Milan, ItalyGiampiero CampanelliDepartment of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, ItalyGiampiero CampanelliDepartment of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant’Ambrogio, Milan, Italy

2021en

ABI

Annotatsiya

BACKGROUND: Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS: Systematic review and network meta-analyses of randomized controlled trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. RESULTS: Thirty-five RCTs (7777 patients) were included. Overall, 3496 (44.9%) underwent Lichtenstein, 1269 (16.3%) TAPP, and 3012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12 hours, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs Lichtenstein (WMD = -3.3; 95% CrI -4.9 to -1.8) and TEP vs Lichtenstein (WMD = -3.6; 95% CrI -4.9 to -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches, whereas no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS: Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.

Hali tarjima qilinmagan

Identifikatorlar

DOI: 10.1097/sla.0000000000004735

Iqtiboslar va manbalar

2 ta iqtibos0 ta foydalanilgan manba

Koʻrsatkichlar — AkademScholar