非中线切口的预防性网片加固:系统回顾

HCA healthcare journal of medicine Pub Date : 2024-04-30 eCollection Date: 2024-01-01 DOI:10.36518/2689-0216.1576
Rainna Coelho, Oluwatunmininu Anwoju, Ali Siddiqui, Andrew Youssef, Oscar A Olavarria, Naila H Dhanani, Karla Bernardi, Zuhair Ali, Mike K Liang
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引用次数: 0

摘要

背景:许多腹盆腔手术使用的切口不在白线上,如横切口、腹腔镜切口、造口翻转切口或造口形成切口。这些部位腹侧切口疝(VIH)的发病率以及预防性网片对预防 VIH 的效果仍不清楚:方法:我们对 PubMed、Embase、Scopus 和 Cochrane 数据库从开始到 2022 年 9 月的内容进行了系统回顾。我们纳入了已发表的随机对照试验(RCT),这些试验对预防性网片加固与无网片进行了比较。主要结果是术后随访 24 个月或 24 个月以上的 VIH 发生率。次要结果包括手术部位感染(SSI)和手术部位发生率(SSO):在筛选出的 3186 篇文章中,只有 3 篇随访 2 年的 RCT(随访率至少达到 80%)纳入了非中线 VIH 分析,共涉及 901 名患者。另外还纳入了 15 项研究性临床试验,对次要结果进行分析。使用预防性网片的腹股沟旁疝发生率为 21%,而对照组的发生率为 44%-64% 不等。预防性网片造口翻转术后切口疝的发生率为 10%,对照组为 16%。没有明确证据表明不同组间的 SSI 或 SSO 发生率存在差异:关于预防性网片在预防非中线 VIH 方面作用的证据有限。需要更多低偏倚风险的研究来阐明非中线切口预防性网片的长期风险和益处之间的平衡。
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Prophylactic Mesh Reinforcement for Non-Midline Incisions: A Systematic Review.

Background: Many abdominal-pelvic surgeries utilize incisions not along the linea alba, such as transverse, laparoscopic, ostomy reversal, or ostomy formation incisions. The prevalence of ventral incisional hernias (VIH) at these sites and the efficacy of prophylactic mesh in preventing VIH remains unclear.

Methods: PubMed, Embase, Scopus, and Cochrane databases were systematically reviewed from inception to September 2022. We included published randomized controlled trials (RCTs) that compared prophylactic mesh reinforcement versus no mesh. The primary outcome was the incidence of VIH at postoperative follow-up equal to or greater than 24 months. Secondary outcomes included surgical site infection (SSI) and surgical site occurrence (SSO).

Results: Of 3186 screened articles, only 3 RCTs with at least an 80% 2-year follow-up, encompassing a total of 901 patients, were included for analysis of non-midline VIH. Fifteen additional RCTs were included for analysis of secondary outcomes. The rate of parastomal hernias with prophylactic mesh was 21%, while it ranged from 44%-64% in the control group. The rate of incisional hernia after ostomy reversal with prophylactic mesh was 10%, and 16% in the control group. No clear evidence of a difference was found in rates of SSI or SSO between groups.

Conclusion: There is limited evidence on the role of prophylactic mesh in preventing non-midline VIH. More studies at low risk for bias are needed to elucidate the balance of the long-term risks and benefits of prophylactic mesh for non-midline incisions.

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