The Effect Of Different Operative Methods On Abdominal Incisional Hernia And The Influence Of Obesity On The Complications Of Incisional Hernia

Objective:1.To evaluate the clinical effect of laparoscopic and open surgery in the treatment of abdominal incisional hernia by meta analysis.2.To compare the clinical effect of open operation,laparoscopic operation and hybrid operation on abdominal incisional hernia.To explore the relationship between obesity and the outcome of abdominal incisional hernia and postoperative complications.Methods:1.The medical databases Pub Med,EMBASE,Cochrane Library,web of science,CNKI,Wan Fang data,VIP data and CBM were retrieved by computer.The retrieval time was from the establishment of the database to November 2019.To search and compare the literature of laparoscopic surgery and open surgery in the treatment of abdominal incisional hernia.To evaluate the quality of the literature included in this study.The operative time,bleeding volume,hospitalization time,postoperative complications and recurrence rate of the two methods were compared.2.The clinical data of 94 patients with abdominal incisional hernia admitted to the First Affiliated Hospital of Fujian Medical University from January 2015 to November 2019 were analyzed retrospectively.The clinical outcome indexes of the three groups were analyzed,and the difference was statistically significant.The size of visceral fat area(VFA)and subcutaneous fat area(SFA)were obtained by Image Pro Plus 6.0 software.To explore the relationship between VFA and VFA / SFA ratio and intraoperative and postoperative complications.Results:1.A total of 693 related literatures were retrieved and further screened according to the exclusion criteria.Finally,22 related randomized controlled literatures were included,with a total of 1812 cases.The results showed that compared with open incision hernia repair,laparoscopic repair could reduce the amount of bleeding(MD =-46.10,95% CI:-69.99 ～-29.22,P < 0.0001),and shorten the hospital stay(RR =-2.63,95% CI:-3.16 ～-2.09,P < 0.00001).The incidence of postoperative serum swelling(RR = 0.36,95% CI: 0.19 ～ 0.71,P = 0.003)and postoperative incision infection(RR = 0.25,95% CI: 0.15 ～ 0.41,P < 0.001)were lower in the laparoscopic group.Compared with the open operation group,the incidence of intestinal injury during laparoscopic repair(RR = 2.24,95% CI: 0.98 ～ 5.10,P = 0.05),and the incidence of postoperative pain related complications were higher(RR = 1.61,95%CI: 0.31 ～ 18.35,P = 0.02).The operative time of the two groups(MD =-5.54,95%CI:-15.49 ～ 4.41,P = 0.28),postoperative intestinal obstruction(RR = 0.83,95%CI:0.40 ～ 1.73,P = 0.62),postoperative bleeding(RR = 1.18,95%CI:0.41 ～ 8.71,P = 0.42),postoperative hematoma(RR = 0.81,95%CI:0.50 ～ 1.34,P = 0.42),and postoperative urinary retention rate(RR = 1.13,95%CI:0.40 ～ 3.21,P = 0.81)There was no significant difference in reoperation rate(RR = 0.62,95% CI: 0.32 ～ 1.21,P =0.16)and recurrence rate(RR = 1.25,95% CI: 0.85 ～ 1.83,P = 0.26).After subgroup analysis,it was found that high BMI was a risk factor for postoperative complications of incisional hernia.2.The results of this study showed that there was no significant difference in operation time,bleeding volume and hospital stay between the open operation group and laparoscopic operation group.Compared with the other two groups,the hybrid operation group had longer operation time,more intraoperative blood volume and longer hospital stay(P < 0.05).In terms of postoperative complications,the incidence of serum swelling in the hybrid operation group was higher than that in the other two groups(P < 0.05).There was no significant difference in the incidence of total complications among the three groups(P > 0.05).There was no significant difference between VFA and VFA / SFA in terms of operation time,intraoperative bleeding volume and hospitalization time(P > 0.05).In terms of the incidence of surgical complications,the total incidence of surgical complications was higher in the high VFA group(P < 0.05).The incidence of postoperative intestinal obstruction and adverse incision events(seroma,hematoma,poor incision healing and infection)were higher in the VFA / SFA group(P < 0.05),and the incidence of total operative complications was higher in the VFA / SFA group(P < 0.01).Conclusion:1.Compared with open repair surgery,there were no significant differences in postoperative ileus,postoperative bleeding,postoperative hematoma,postoperative urinary retention,recurrence rate and recurrence rate.The incidence of serum swelling and incision infection was lower in laparoscopic operation group than that in open operation group.Laparoscopic repair can reduce the amount of bleeding and shorten the hospital stay.However,the incidence of postoperative pain related complications in laparoscopic surgery is higher than that in open surgery.2.Different surgical methods are safe and effective in the treatment of incisional hernia.There were differences in operation time,bleeding volume,hospitalization time,postoperative serum swelling and postoperative pain;Obesity may be the influencing factor of postoperative complications;VFA is the risk factor of postoperative incision adverse events and overall complications;VFA / SFA are the risk factors of postoperative intestinal obstruction,postoperative adverse events and overall complications.