Should asymptomatic contralateral inguinal hernia be laparoscopically repaired in the adult population as benefits greatly outweigh risks? A systematic review and meta-analysis,Hernia

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Should asymptomatic contralateral inguinal hernia be laparoscopically repaired in the adult population as benefits greatly outweigh risks? A systematic review and meta-analysis
Hernia ( IF 2.6 ) Pub Date : 2022-04-18 , DOI: 10.1007/s10029-022-02611-z
Jung B Park ₁ , Darren C Chong ₁ , Jessica L Reid ₁ , Suzanne Edwards ₁ , Guy J Maddern _{1,

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Affiliation

Purpose

When laparoscopically repairing a symptomatic inguinal hernia, surgeons will discover a contralateral asymptomatic hernia in 22% of patients. It is estimated 30% of asymptomatic hernias become symptomatic and require repair. Thus, should they be repaired in a 2-for-1 operation? The main purpose is to examine the evidence and make a recommendation for the need to repair the contralateral asymptomatic inguinal hernia prophylactically in the adult population during unilateral inguinal hernia presentation.

Method

A systematic literature search was conducted up to 15 February 2021 using PubMed and the Cochrane Library. Management pathway taken, mean operating time, duration of follow-up, pain, duration of hospital stay and perioperative complications were extracted. Risk of bias was assessed using the ROBINS-I tool.

Results

Six non-randomised studies (1774 patients) were included; 978 patients had both hernias repaired, 796 patients had only the symptomatic hernia repaired. There was no significant difference in length of hospital stay, return to activities of daily living nor complications. Mean operating time was slightly lower for patients who had unilateral hernia repair (mean difference = − 14.57 min, 95%CI − 25.59, − 3.45). Reported pain scores were lower for patients who only had one hernia repaired (− 0.33 units, 95%CI − 0.48, − 0.18). The overall risk of bias for the six studies were low-to-moderate risk.

Conclusion

Asymptomatic inguinal hernias can be repaired when found. While there is minimal increase in operation time and pain, no significant difference to total hospital stay. Importantly, this is likely to prevent the need for another operation in almost a third of patients.

中文翻译：

无症状对侧腹股沟疝是否应该在成年人群中进行腹腔镜修复，因为益处远大于风险？系统评价和荟萃分析

目的

在腹腔镜下修复有症状的腹股沟疝时，外科医生会在 22% 的患者中发现对侧无症状疝。据估计，30% 的无症状疝会出现症状并需要修复。因此，它们是否应该以 2 比 1 的方式进行修复？主要目的是检查证据并就成人单侧腹股沟疝出现时需要预防性修复对侧无症状腹股沟疝提出建议。

方法

截至 2021 年 2 月 15 日，使用 PubMed 和 Cochrane 图书馆进行了系统的文献检索。提取所采取的管理途径、平均手术时间、随访时间、疼痛、住院时间和围手术期并发症。使用 ROBINS-I 工具评估偏倚风险。

结果

包括六项非随机研究（1774 名患者）；978例患者双侧疝修复，796例仅修复症状性疝。住院时间、恢复日常生活活动和并发症无显着差异。单侧疝修补术患者的平均手术时间略短（平均差 = - 14.57 分钟，95%CI - 25.59， - 3.45）。仅修复一处疝的患者报告的疼痛评分较低（- 0.33 单位，95% CI - 0.48，- 0.18）。六项研究的总体偏倚风险为低至中等风险。