Meta-analysis of clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia

doi:10.3877/cma.j.issn.1674-392X.2021.04.022

Abstract

Abstract:

Objective

To study the clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia.

Methods

PubMed, China Biomedical Literature Service System, China HowNet and Wanfang database were retrieved by computer. The clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia from database building to June 2019 were collected and strictly reviewed by two researchers according to the inclusion/exclusion criteria. The two researchers independently completed literature screening, related data extraction and quality evaluation. Data were analyzed by RevMan 5.3 statistical software.

Results

10 studies involving 2583 patients were included. The results of meta-analysis showed that: (1) There was no significant difference in operation time between the experimental group and the control group (P>0.05); Subgroup analysis results: in tension-free repair group (including Lichtenstein) and TEP group, the operation time of the experimental group was not significantly different from that of the control group (P>0.05), while in open posterior preperitoneal approach group, the operation time of the experimental group was significantly different from that of the control group (P<0.05). (2) There was no significant difference in anal exhaust time between the experimental group and the control group (P>0.05). (3) The length of hospital stay of the experimental group was significantly different from that of the control group (P>0.05); Subgroup analysis results: the length of hospital stay of the experimental group was not significantly different from that of the control group in the tension-free repair group (P>0.05), while the length of hospital stay of the experimental group was significantly different from that of the control group in the TEP group and the open posterior preperitoneal approach operation group (P<0.05). (4) There was significant difference in postoperative complications between the experimental group and the control group (P<0.05); Subgroup analysis results: in tension-free repair group and open posterior preperitoneal approach operation group, the postoperative complications of the experimental group were significantly different from those of the control group (P<0.05), while in TEP group, the postoperative complications of the experimental group were not significantly different from those of the control group (P>0.05). (5) There was no significant difference in the recurrence rate between the experimental group and the control group (P<0.05); Subgroup analysis results: in the tension-free repair group, the postoperative recurrence rate of the experimental group was significantly higher than that of the control group (P<0.05), while in the TEP group and the open posterior preperitoneal approach operation group, the hospital stay of the experimental group was not significantly different from that of the control group (P>0.05).

Conclusion

Laparoscopic transabdominal preperitoneal herniorrhaphy has great advantages in the treatment of recurrent inguinal hernia with less postoperative complications and low recurrence rate, and it is worthy of clinical application.

Key words: Recurrent inguinal hernia, Transabdominal preperitoneal hernioplasty, Laparoscopy, Meta-analysis

Fang Li, Junfeng Wang. Meta-analysis of clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernioplasty for recurrent inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(04): 401-409.

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URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2021.04.022

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Figures/Tables 13

References 24

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文献来源	总例数	试验组			对照组			随访时间
文献来源	总例数	例数	年龄(岁, ±s)	手术方式	例数	年龄(岁, ±s)	手术方式	随访时间
赵坤2018^[8]	54	男(27)	60.10±6.20	TAPP	男(27)	60.60±6.10	腹腔镜全腹膜外疝修补术	未提及
李剑锋2014^[7]	65	男(31),女(3)	55.80±8.90	TAPP	男(29),女(2)	51.60±9.30	Lichtenstein	0.50~7.75个月
汪丽伟2018^[5]	80	男(40)	52.75± 6.29	TAPP	男(40)	52.82±6.23	Lichtenstein	未提及
张盛烺2019^[9]	男(31),女(9)	20(性别未提及)	43.10±2.20	TAPP	20(性别未提及)	43.10±2.20	开放性无张力疝修补手术	未提及
Dedemadi 2006^[10]	82	24	65.0	TAPP	26	65.0	TEP	3.0年
Dedemadi 2006^[10]	82	24	65.0	TAPP	32	65.0	Lichtenstein	3.0年
Eklund 2007^[11]	147	男(73)	52.0±10.40	TAPP	男(74)	55.0±11.30	Lichtenstein	4.90~7.20个月
Yang 2018^[4]	122	59	52.70±16.60	TAPP	63	58.20±13.10	Lichtenstein	3.85±0.57个月
Saber 2015^[12]	180	60	42~65	TAPP	60	42~65	开放性腹膜前后入路手术	2007年1个月-2011年4个月
Saber 2015^[12]	180	60	42~65	TAPP	60	42~65	Lichtenstein	2007年1个月-2011年4个月
Gass 2016^[13]	1309	287	57.8±14.5	TAPP	1022	55.6±14.9	腹腔镜全腹膜外疝修补术	1995-2006年
Lydeking 2020^[14]	265	136	≥18且<81	TAPP	129	≥18且<81	Lichtenstein	12年

文献来源	总例数	试验组			对照组			随访时间
文献来源	总例数	例数	年龄(岁, ±s)	手术方式	例数	年龄(岁, ±s)	手术方式	随访时间
赵坤2018^[8]	54	男(27)	60.10±6.20	TAPP	男(27)	60.60±6.10	腹腔镜全腹膜外疝修补术	未提及
李剑锋2014^[7]	65	男(31),女(3)	55.80±8.90	TAPP	男(29),女(2)	51.60±9.30	Lichtenstein	0.50~7.75个月
汪丽伟2018^[5]	80	男(40)	52.75± 6.29	TAPP	男(40)	52.82±6.23	Lichtenstein	未提及
张盛烺2019^[9]	男(31),女(9)	20(性别未提及)	43.10±2.20	TAPP	20(性别未提及)	43.10±2.20	开放性无张力疝修补手术	未提及
Dedemadi 2006^[10]	82	24	65.0	TAPP	26	65.0	TEP	3.0年
Dedemadi 2006^[10]	82	24	65.0	TAPP	32	65.0	Lichtenstein	3.0年
Eklund 2007^[11]	147	男(73)	52.0±10.40	TAPP	男(74)	55.0±11.30	Lichtenstein	4.90~7.20个月
Yang 2018^[4]	122	59	52.70±16.60	TAPP	63	58.20±13.10	Lichtenstein	3.85±0.57个月
Saber 2015^[12]	180	60	42~65	TAPP	60	42~65	开放性腹膜前后入路手术	2007年1个月-2011年4个月
Saber 2015^[12]	180	60	42~65	TAPP	60	42~65	Lichtenstein	2007年1个月-2011年4个月
Gass 2016^[13]	1309	287	57.8±14.5	TAPP	1022	55.6±14.9	腹腔镜全腹膜外疝修补术	1995-2006年
Lydeking 2020^[14]	265	136	≥18且<81	TAPP	129	≥18且<81	Lichtenstein	12年

纳入研究	随机方法	是否盲法	分配隐藏	结果数据的完整性	选择性报告实验研究结果	其他偏倚控制
赵坤2018^[8]	随机数字表法	否	不清楚	不清楚	不清楚	不清楚
李剑锋2014^[7]	不随机(按患者意愿)	否	不清楚	不清楚	不清楚	不清楚
汪丽伟2018^[5]	随机数据表法	否	不清楚	不清楚	不清楚	不清楚
张盛烺2019^[9]	随机数字表法	否	不清楚	不清楚	不清楚	不清楚
Dedemadi 2006^[10]	随机分配	不清楚	是	是	否	不清楚
Eklund 2007	随机分配	不清楚	是	是	否	不清楚
Eklund 2007^[11]	随机分配	不清楚	是	是	否	不清楚
Yang 2018^[4]	随机分配	不清楚	不清楚	是	否	不清楚
Saber 2015^[12]	仅提及前瞻性	不清楚	不清楚	是	否	不清楚
Lydeking 2020^[14]	随机分配	是	不清楚	是	否	不清楚

纳入研究	随机方法	是否盲法	分配隐藏	结果数据的完整性	选择性报告实验研究结果	其他偏倚控制
赵坤2018^[8]	随机数字表法	否	不清楚	不清楚	不清楚	不清楚
李剑锋2014^[7]	不随机(按患者意愿)	否	不清楚	不清楚	不清楚	不清楚
汪丽伟2018^[5]	随机数据表法	否	不清楚	不清楚	不清楚	不清楚
张盛烺2019^[9]	随机数字表法	否	不清楚	不清楚	不清楚	不清楚
Dedemadi 2006^[10]	随机分配	不清楚	是	是	否	不清楚
Eklund 2007	随机分配	不清楚	是	是	否	不清楚
Eklund 2007^[11]	随机分配	不清楚	是	是	否	不清楚
Yang 2018^[4]	随机分配	不清楚	不清楚	是	否	不清楚
Saber 2015^[12]	仅提及前瞻性	不清楚	不清楚	是	否	不清楚
Lydeking 2020^[14]	随机分配	是	不清楚	是	否	不清楚

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