Anterior component separation techniques: is it necessary to preserve the perforators? a systematic review and meta-analysis.

IF 2.6 2区医学 Q1 SURGERY Hernia Pub Date : 2025-01-09 DOI:10.1007/s10029-024-03243-1

Mariana de Macedo Torves, Carlos André Balthazar da Silveira, Raquel Nogueira, Leandro Totti Cavazzola, Diego L Lima

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Abstract

Background: Anterior component separation (ACS), or Ramirez component separation technique, is an established technique still used by surgeons to repair a ventral hernia. Compared with other ventral hernia repair techniques, recent studies about ACS show more postoperative complications like wound breakdown, wound infection, hematoma, skin necrosis, seroma, and recurrence. Our study aims to compare the ACS technique with the preservation perforator technique and verify if the perforator preservation technique can decrease postoperative complications.

Materials and methods: Cochrane Central, Embase, and PubMed were systematically searched for studies comparing the perforator-sparing ACS ventral hernia repair and the standard technique. Outcomes assessed were wound breakdown, skin necrosis, wound infection, seroma, hematoma, reoperation, and recurrence at least 3 months postoperatively. Statistical analysis was performed with R Studio.

Results: 94 studies were screened, and 11 studies were selected for full-text reading. Seven studies were selected, comprising 761 patients, of which 309 (40.6%) underwent the perforator-sparing ACS technique. We found lower wound breakdown rates for the preservation technique (RR 0.45; 95% CI 0.32; 0.63; p < 0.01). Also, the perforator-sparing technique presented lower reoperation rates (RR 0.59; 95% CI 0.35; 0.72; p < 0.01). No differences were found in skin necrosis (RR 0.22; 95% CI 0.03; 1.63; p = 0.14), wound infection (RR 0.69; 95% CI 0.25; 1.90; p = 0.47), seroma (RR 0.29; 95% CI 0.07; 1.26; p = 0.1), hematoma (RR 0.73; 95% CI 0.11; 5.06; p = 0.75), or recurrence (RR 0.81; 95% CI 0.37; 1.74; p = 0.59) rates.

Conclusion: Our comprehensive systematic review with meta-analysis compared the perforator-sparing ACS with the standard technique and found lower wound breakdown and reoperation rates for the perforator-sparing technique. No differences were found in the other outcomes analyzed.

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前体分离技术：有必要保留穿支吗？系统回顾和荟萃分析。

背景：前成分分离（ACS），或Ramirez成分分离技术，是外科医生仍在使用的一种成熟的技术来修复腹疝。与其他腹疝修补技术相比，近期研究显示ACS术后出现更多的创面破裂、创面感染、血肿、皮肤坏死、血清肿、复发等并发症。我们的研究旨在比较ACS技术与保留穿支技术，并验证保留穿支技术是否可以减少术后并发症。材料和方法：系统检索Cochrane Central、Embase和PubMed，比较保留穿孔的ACS腹疝修补术与标准技术的研究。评估的结果包括伤口破裂、皮肤坏死、伤口感染、血肿、血肿、再手术和术后至少3个月的复发。使用R Studio进行统计分析。结果：筛选94项研究，选择11项研究进行全文阅读。我们选择了7项研究，包括761例患者，其中309例（40.6%）接受了保穿孔ACS技术。我们发现保存技术的伤口击穿率较低(RR 0.45；95% ci 0.32；0.63;结论：我们的综合系统评价和荟萃分析比较了保留穿孔的ACS与标准技术，发现保留穿孔技术的伤口破裂和再手术率更低。在其他结果分析中没有发现差异。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

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.