Balloon dissection versus telescopic dissection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a systematic review, meta-analysis, and trial sequential analysis,Hernia

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Balloon dissection versus telescopic dissection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair: a systematic review, meta-analysis, and trial sequential analysis
Hernia ( IF 2.6 ) Pub Date : 2023-05-15 , DOI: 10.1007/s10029-023-02793-0
V Satish Kolli ₁ , K Kumar ₂ , S Hajibandeh ₃ , S Hajibandeh ₄

Affiliation

Objectives

To compare the outcomes of balloon dissection and telescopic dissection in patients undergoing laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Methods

A systematic review in accordance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies comparing the outcomes of balloon dissection and telescopic dissection in patients undergoing laparoscopic TEP inguinal hernia repair. Random effects modelling was applied to calculate pooled outcome data.

Results

A total of 936 patients from eight studies were included. The included population in both groups were comparable in terms of baseline characteristics. There was no difference between the two techniques in terms of operation time (MD: − 4.14 min, P = 0.05), conversion to another technique (RD: − 0.02, P = 0.29), recurrence (RD: − 0.00, P = 0.84), haematoma (OR: 1.34, P = 0.61), seroma (OR: 0.63, P = 0.56), surgical site infection (RD: 0.00, P = 1.00), urinary retention (OR: 0.92, P = 0.86), postoperative pain score on day 1 (MD: − 0.16, P = 0.69) and day 7 (MD: − 0.16, P = 0.61). Trial sequential analysis of randomised trials suggested that evidence for operative time and conversion to other technique is subject to type 1 and type 2 error.

Conclusions

Balloon dissection and telescopic dissection during TEP inguinal hernia repair are comparable in terms of operative and postoperative outcomes. The available evidence for operative time and conversion to other technique is subject to type 1 and type 2 error. In presence of comparative clinical outcomes, the cost-effectiveness analysis in future studies may play an important role in determining the dissection technique of choice.

中文翻译：

腹腔镜完全腹膜外 (TEP) 腹股沟疝修补术中球囊剥离与伸缩剥离的比较：系统评价、荟萃分析和试验序贯分析

目标

比较接受腹腔镜完全腹膜外 (TEP) 腹股沟疝修补术的患者球囊剥离和伸缩剥离的结果。

方法

根据 PRISMA 声明标准进行了系统审查。对电子信息来源进行了搜索，以确定所有比较球囊剥离和伸缩剥离在接受腹腔镜 TEP 腹股沟疝修补术患者中的结果的研究。应用随机效应模型来计算合并的结果数据。

结果

共有来自八项研究的 936 名患者被纳入。两组中的纳入人群在基线特征方面具有可比性。两种技术在手术时间（MD：- 4.14 分钟，P = 0.05）、转换为另一种技术（RD：- 0.02，P = 0.29）、复发率（RD：- 0.00，P = 0.84）方面没有差异)、血肿(OR: 1.34, P = 0.61)、血清肿(OR: 0.63, P = 0.56)、手术部位感染(RD: 0.00, P = 1.00)、尿潴留(OR: 0.92, P = 0.86)、术后第 1 天（MD：- 0.16，P = 0.69）和第 7 天（MD：- 0.16，P = 0.61）的疼痛评分。随机试验的试验序贯分析表明，手术时间和转换为其他技术的证据容易出现 1 型和 2 型错误。