Safety, feasibility and clinical outcome of minimally invasive inguinal hernia repair in patients with previous radical prostatectomy: A systematic review of the literature.
Safety, feasibility and clinical outcome of minimally invasive inguinal hernia repair in patients with previous radical prostatectomy: A systematic review of the literature.
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DOI：
10.4103/jmas.jmas_218_18
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发表时间：
2019-10
影响因子：
0.8
通讯作者：
Mongelli F
中科院分区：
文献类型：
--
作者：
La Regina D;Gaffuri P;Ceppi M;Saporito A;Ferrari M;Di Giuseppe M;Mongelli F
根治性腹股沟疝切除术（RP）是原发性腹股沟疝（IH）发生的重要后天风险因素，术后前2年内的估计发病率为15.9%。腹腔镜手术相关的腹膜前纤维化反应使得腹腔镜下修补IH在技术上变得困难，即使安全性和可行性尚未得到广泛评价。我们对现有文献进行了系统回顾。根据系统性综述和荟萃分析的首选报告项目指南，对PubMed和MEDLINE数据库进行了全面的计算机文献检索。用于检索的术语为（“腹腔镜”或“腹腔镜”）和（“腹股沟”或“腹股沟"或”疝“）和”腹股沟切除术“。从PubMed和MEDLINE数据库中检索的文献显示了156篇文章。5篇文章被认为有资格进行分析，包括229例接受277例疝修补术的患者。汇总分析表明，术后并发症无统计学显著差异（风险比[RR] 2.06; 95%置信区间[CI] 0.85-4.97），转为开放手术疝切除术后组与对照组之间的差异（RR 3.91; 95% CI 0.85-18.04）和疝复发（RR 1.39; 95% CI 0.39-4.93）。由于腹壁下血管损伤，轻微术中并发症（RR 4.42; CI 1.05-18.64）存在统计学显著差异。我们的系统性综述表明，在经验丰富的医生中，既往接受过腰椎切除术的患者中，微创修复IH的安全性、可行性和临床结局与既往未接受RP的患者相当。
Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature. A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were (‘laparoscopic’ OR ‘laparoscopy’) AND (‘inguinal’ OR ‘groin’ OR ‘hernia’) AND ‘prostatectomy’. The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85–4.97), conversion to open surgery (RR 3.91; 95% CI 0.85–18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39–4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05–18.64), due to an injury of the inferior epigastric vessels. Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP.