Ballem Naveen, Parikh Rikesh, Berber Eren, Siperstein Alan
Department of Surgery, Cleveland Clinic, 9500 Euclid Avenue, Crile A-80, Cleveland, OH 44195, USA.
Surg Endosc. 2008 Sep;22(9):1935-40. doi: 10.1007/s00464-008-9981-1. Epub 2008 Jun 5.
Current studies with 2-3 year follow-up favor laparoscopic ventral hernia repair due to lower recurrence rates, fewer wound infections, and shorter hospital stays. There is scant data in the literature for this group of patients regarding longer follow-up. This study compares the actual 5 year recurrence rates of laparoscopic versus open techniques and determines factors that may affect recurrence.
A retrospective analysis of ventral hernia repairs at a tertiary center between January 1996 and December 2001 was performed. In this era, the method of repair often depended on which surgeon evaluated the patient. All patients were followed for a minimum of 5 years (median 7.5 years). Demographic and clinical parameters were analyzed using Kaplan-Meier analyses and the multivariate Cox proportional hazard model.
Of 331 patients, 119 underwent laparoscopic ventral hernia repair (LAP), 106 open hernia repair with mesh (O-M), 86 open suture repair (O-S), and 20 laparoscopic converted to open (LCO). Statistical analyses showed equal parameters among groups except defect sizes (mean +/- standard error on the mean [SEM]): LAP (9.8 +/- 1.2 cm), O-M (11.2 +/- 3.3 cm), LCO (16.6 +/- 5.4 cm) versus O-S (4.6 +/- 1.6 cm) (p < 0.02). Actual recurrence rates at 1 and 5 years were LAP (15% and 29%), O-M (11% and 28%), O-S (10% and 19%), and LCO (35% and 60%). Multivariate analysis identified larger defects to have higher recurrence rates, particularly in the O-S group (p < 0.02). With the exception of the LCO group, surgical technique did not predict recurrence, nor did body mass index, diabetes, smoking, or use of tacks versus sutures.
This is the first study to compare 5 year actual recurrence rates between laparoscopic and open ventral hernia repairs. Contrary to prior reports, our longer-term data indicates similar recurrence rates, except for higher rates in the laparoscopic converted to open group. Due to the continued recurrences over the period studied, longer-term follow-up is necessary to appreciate the true rate of hernia recurrence.
目前随访2至3年的研究表明，腹腔镜腹疝修补术因复发率较低、伤口感染较少且住院时间较短而更具优势。关于这组患者更长时间随访的文献数据较少。本研究比较了腹腔镜与开放手术技术的实际5年复发率，并确定可能影响复发的因素。
对1996年1月至2001年12月在一家三级中心进行的腹疝修补术进行回顾性分析。在这个时期，修复方法通常取决于评估患者的外科医生。所有患者至少随访5年（中位时间7.5年）。使用Kaplan-Meier分析和多变量Cox比例风险模型分析人口统计学和临床参数。
331例患者中，119例行腹腔镜腹疝修补术（LAP），106例行开放疝修补术并使用补片（O-M），86例行开放缝合修补术（O-S），20例行腹腔镜中转开放手术（LCO）。统计分析显示，除缺损大小外（均值±均值标准误[SEM]），各组参数相等：LAP（9.8±1.2 cm）、O-M（11.2±3.3 cm）、LCO（16.6±5.4 cm）与O-S（4.6±1.6 cm）（p<0.02）。1年和5年的实际复发率分别为：LAP（15%和29%）、O-M（11%和28%）、O-S（10%和19%）、LCO（35%和60%）。多变量分析表明，较大的缺损复发率较高，尤其是在O-S组（p<0.02）。除LCO组外，手术技术、体重指数、糖尿病、吸烟或使用钉合器与缝合线均不能预测复发。
这是第一项比较腹腔镜与开放腹疝修补术5年实际复发率的研究。与先前报道相反，我们的长期数据表明复发率相似，但腹腔镜中转开放组的复发率较高。由于在所研究期间复发持续存在，因此需要更长时间的随访以了解疝复发的真实发生率。
