Open surgical procedures for incisional hernias

Abstract

Incisional hernias occur frequently after abdominal surgery and can cause serious complications. The choice of a type of open operative repair is controversial. Determining the type of open operative repair is controversial, as the recurrence rate may be as high as 54%. This a update of an earlier version. To identify the best available open operative techniques for incisional hernias. Electronic databases MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1990 to 14 September 2010 and trials were identified from the known trial reference lists. Studies were eligible for inclusion if they were randomized trials comparing different techniques for open operative techniques for incisional hernias. Statistical analyses were performed using the fixed effects model. Results were expressed as relative risk for dichotomous outcomes and weighted mean difference for continuous outcomes with 95% confidence intervals. Eight trials comparing different open repairs for incisional hernias were identified; one trial was excluded. The included studies enrolled 1,141 patients. The results of three trials comparing suture repair versus mesh repair were pooled. Hernia recurrence was more frequent, wound infection less frequent in the direct suture group compared to the onlay or sublay mesh groups. The recurrence rates of two trials comparing onlay and sublay positions were pooled. This comparison yielded no difference in recurrences (two studies pooled), although operation time was shorter in the onlay group (one study). No difference was found in recurrence, satisfaction with cosmetics, or infection between the onlay standard mesh and skin autograft groups, following analysis pooling the two treatment arms. However, the analysis demonstrated less pain in the skin autograft group. Other trials comparing different mesh materials or different positions of the mesh, or comparing mesh with the components separation technique are described individually. The comparison between lightweight and standard mesh showed a trend for more recurrences in the lightweight group. The comparison between onlay and intraperitoneal mesh positions resulted in non significant fewer hernia recurrences, less seroma formation and more postoperative pain in the intraperitoneal group. No differences in the recurrence rates between the components separation and the intraperitoneal mesh technique. An update in October 2010 did not yield any further studies. There is good evidence from three trials that open mesh repair is superior to suture repair in terms of recurrences, but inferior when considering wound infection. Six trials yielded insufficient evidence as to which type of mesh or which mesh position (on‐ or sublay) should be used. There was also insufficient evidence to advocate the use of the components separation technique. 切口疝氣的開放式手術程序 切口疝氣經常出現腹部手術後，並可能導致嚴重的併發症。選擇那一個類型的開放式手術修復是有爭議的。確定那一個開放式手術修復也是有爭議的，因為復發率可高達54％ 確定切口疝氣的最佳開放式手術技術 電子數據庫 MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL)被搜查1990年至2007年,從已知參考文獻目錄確定了試驗. 有資格列入研究的包括,比較切口疝氣的開放性手術技術,不同技術的隨機試驗. 進行統計分析採用固定效應模式.結果表現為相對危險度兩分法和加權平均的結果差異連續結果95％的置信區間 八個試驗比較確定的切口疝氣,不同的開放性修補; 一個試驗被排除在外.研究包括納入的1141例.統整三個試驗比較縫合修復與mesh修復.與onlay 或 sublay mesh組相比, 直接縫合組疝氣復發更加頻繁,傷口感染較少發生.比較兩個試驗的復發率onlay and sublay positions were pooled.這個比較在復發上沒有產生差異(彙整兩個研究), 雖然onlay組的手術時間較短(一個研究),在復發上,整形上的滿意度或在onlay standard mesh和皮膚自體移植組之間的感染,沒有不同的發現.下面的分析集中在兩個治療小組.然而，分析表明,皮膚移植組疼痛減少,其他的試驗比較不同的mesh材質或不同的mesh位置, mesh和各組成部分的分離技術.比較輕量的和標準的mesh顯示輕量組有較高的復發趨勢,比較onlay 和腹腔內mesh的位置兩者之間並沒有顯著的較少的疝氣復發,在腹腔內組有較少血清腫形成,但是術後疼痛較多,成分分離和腹腔內mesh技術在復發率上沒有不同 這三次試驗有很好的證據顯示在復發上,開放性的mesh修補比縫合修補好.6個試驗取得了足夠的證據以哪種類型的mesh或mesh位置應該使用.但是提倡使用組件的分離技術上,證據仍然不足. 本摘要由國泰綜合醫院張世昌翻譯 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌 切口疝氣的開放式手術程序:一個切口疝氣是一種膨脹的組織或器官通過在腹壁的手術疤痕.在腹部手術後百分之10至23的患者發生切口疝氣.這次審查的問題，選擇開放手術修復技術，由於高失敗率有點爭議,報告高達54％.開放性的mesh修補比起開放性縫補修補失敗率較低(復發).但是mesh修補合併比較多的傷口感染.由於缺乏試驗,我們並沒有得到哪一種mesh可以被使用的結論. 有關於mesh的位置,也沒有任何推論，(筋膜上或下). 要回答這些遺留的問題,須更多的隨機臨床試驗. Interventions chirurgicales ouvertes pour le traitement des hernies incisionnelles Les hernies incisionnelles sont fréquentes après une chirurgie abdominale et peuvent entraîner des complications graves. Le choix de la réparation chirurgicale ouverte la plus appropriée est controversé. Il est difficile de...