腹腔鏡全腹膜外疝氣修補手術是否需要固定人工網膜?:系統性文獻回顧及統合分析
溫晨越、羅啟文、蔡曜州、楊緒棣、謝政興、張尚仁
台北慈濟醫院 外科部泌尿科
Does mesh fixation necessary in laparoscopic total extra-peritoneal hernia repair? : A Systemic Review and Meta-analysis
Chen-Yueh Wen, Chi-Wen Lo, Yao-Chou Tsai, Stephen Shei-Dei Yang, Cheng-Hsing Hsieh, Shang-Jen Chang
Division of Urology, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
Purpose: We systemically reviewed the published literatures and pooled the data for meta-analysis to compare the efficacy and safety of mesh fixation versus non-fixation during laparoscopic total extra-peritoneal (TEP) hernia repair.
Materials and Methods: We performed a systemic search of PubMED® and Cochrane review for all randomized controlled trials that compared the efficacy and complications of mesh fixation versus non-fixation during TEP hernia repair. The evaluated outcomes included perioperative (operative time, conversion rate) and post-operative parameters (pain scores, duration of hospital stay and surgical complications including seroma, delay return of bladder function, chronic pain, and recurrence). The Cochrane Collaboration Review Manager software (RevMan®, Version 5.2.6) was used for statistical analysis.
Results: There were 10 trials met the inclusion criteria and were included for pooled analysis. Totally, there were 1099 patients and1467 hernia received TEP hernia repair (748 and 719 hernia defects in non-fixation and fixation group, respectively). The non-fixation group required less operative time (WMD= -2.36 minutes, p=0.0006) and had less pain on postoperative day 1 (WMD: -0.44, p=0.04) than the fixation group. There was no significant difference were observed with regard to conversion rate, hospital stay, recurrence rate and complication rate between groups. But the incidence of postoperative urine retention was higher in fixation group (OR: 0.26, p= 0.03).
Conclusion: Non-fixation of mesh yielded a comparable efficacy with mesh fixation in selected patients and had short-term postoperative pain and lower risk of urine retention. Additionally, non-fixation method required shorter operative time and costs. However, no difference in incidence of chronic pain was observed.