Περίληψη:
Background For the scientific evaluation of the endoscopic and open mesh
techniques for the repair of inguinal hernia, meta-analyses of randomized
controlled trials (RCT) are necessary. The Lichtenstein repair is one of the
most common open mesh techniques and therefore of special interest.
Methods After an extensive search of the literature and a quality assessment,
a total of 34 RCT comparing endoscopic procedures both transabdominal
preperitoneal (TAPP) and total extraperitoneal (TEP)—with various open mesh
repairs were deemed to be suitable for a formal meta-analysis of the relevant
parameters. These studies included data for 7,223 patients. Trials that used
the Lichtenstein repair for the control group (23 of 34 trials) were
analyzed-separately.
Results Significant advantages for the endoscopic procedures compared with the
Lichtenstein repair include a lower incidence of wound infection (Peto odds
ratio, 0.39; 95% confidence interval, 0.26, 0.61), a reduction in hematoma
formation (0.69 [0.54, 0.90]) and nerve injury (0.46 [0.35, 0.61]), an earlier
return to normal activities or work (–1.35[–1.72, –0.97]), and fewer incidences
of chronic pain syndrome (0.56[0.44, 0.70]). No difference was found in total
morbidity or in the incidence of intestinal lesions, urinary bladder lesions,
major vascular lesions, urinary retention and testicular problems. Significant
advantages for the Lichtenstein repair include in a shorter operating time
(5.45[1.18, 9.73]), a lower incidence of seroma formation (1.42[1.13, 1.79]),
and fewer hernia recurrences (2.00[1.46, 2.74]). Similar results are seen when
endoscopic procedures are compared with other open mesh repairs. However, in
this comparison, total morbidity was lower with the endoscopic operations
(0.73[0.61, 0.89]). The incidence of seroma formation, chronic pain syndromes,
and hernia recurrence was not significantly different.
Conclusion Endoscopic repairs do have advantages in terms of local
complications and pain-associated parameters. For more detailed evaluation
further well structured trials with improved standardization of hernia type,
operative technique, and surgeons’ experience are necessary.
Λέξεις-κλειδιά:
βουβωνοκήλη, λαπαροσκόπηση, ανοιχτή, αποκατάσταση, ανασκόπηση
