Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
J Surg Res. 2013 May 1;181(1):e1-5. doi: 10.1016/j.jss.2012.06.028. Epub 2012 Jul 6.
Most studies regarding laparoscopic ventral hernia repair (LVHR) have merged primary hernias (PHs) and secondary (incisional) hernias (SHs) into one group of ventral hernias. This grouping could produce falsely favorable results for LVHR. Our objective was to review and compare the outcomes of laparoscopic repair of PHs and SHs.
A retrospective chart review of patients from 2000 to 2010 identified the cases of LVHR at two affiliated institutions. The demographics, comorbidities, type of hernia (PH versus SH), and short- and long-term complications were analyzed. The postoperative pain, cosmetic satisfaction, and Activities Assessment Scale scores were assessed by telephone survey.
A total of 201 cases of LVHR were identified: 73 PHs (36%) and 128 SHs (64%). No difference was found in the mean age between the two groups. The PH group had a greater percentage of black patients (34% versus 14%; P < 0.05), and the SH group had a greater percentage of white patients (85% versus 65%; P < 0.05). More female patients had SHs (34% versus 14%; P < 0.05), and more male patients had PHs (86% versus 66%; P < 0.05). More patients in the SH group had chronic obstructive pulmonary disease (19% versus 7%; P < 0.05) and prostate disease (32% versus 9%; P < 0.05). Overall, the SHs were larger (37.9 ± 4.9 cm(2)versus 11.5 ± 1.9 cm(2); P < 0.01). No differences were found in early postoperative complications, including pneumonia, urinary tract infection, surgical site infection, and seromas between the two groups. However, those with SHs had a greater incidence of recurrence (16% versus 5%; P < 0.05) and mesh explantation (7% versus 0%; P < 0.05). The patients who also underwent SH repairs had greater postoperative pain scores when followed up for a median of 25 mo than those who underwent PH repairs when followed up for a median of 24 mo (3.5 ± 0.4 versus 1.8 ± 0.4; P < 0.05). More patients in the SH group had chronic pain issues (26% versus 5%; P = 0.0003) and had lower satisfaction scores (7.5 ± 0.3 versus 8.6 ± 0.3; P < 0.05). Overall, the Activities Assessment Scale scores were not significantly different.
Our data have demonstrated that PHs and SHs are different. LVHR of SHs is associated with increased recurrence, greater postoperative pain scores, chronic pain issues, and lower patient satisfaction scores. We recommend that future studies evaluate LVHR for PHs separate from those for SHs.
大多数关于腹腔镜腹疝修补术（LVHR）的研究将原发性疝（PH）和继发性（切口）疝（SH）合并为一组腹疝。这种分组可能会对 LVHR 的结果产生错误的有利影响。我们的目的是回顾和比较 PH 和 SH 的腹腔镜修复结果。
对 2000 年至 2010 年期间两家附属医院的患者进行回顾性图表审查，确定了 LVHR 的病例。分析人口统计学、合并症、疝类型（PH 与 SH）以及短期和长期并发症。通过电话调查评估术后疼痛、美容满意度和活动评估量表评分。
共确定了 201 例 LVHR：73 例 PH（36%）和 128 例 SH（64%）。两组之间的平均年龄无差异。PH 组黑人患者比例较高（34%对 14%；P < 0.05），SH 组白人患者比例较高（85%对 65%；P < 0.05）。更多的女性患者有 SH（34%对 14%；P < 0.05），更多的男性患者有 PH（86%对 66%；P < 0.05）。SH 组中更多的患者患有慢性阻塞性肺疾病（19%对 7%；P < 0.05）和前列腺疾病（32%对 9%；P < 0.05）。总体而言，SH 的大小更大（37.9 ± 4.9 cm2 对 11.5 ± 1.9 cm2；P < 0.01）。两组之间的早期术后并发症，包括肺炎、尿路感染、手术部位感染和血清肿，无差异。然而，SH 组的复发率（16%对 5%；P < 0.05）和网片取出率（7%对 0%；P < 0.05）更高。当随访中位数为 25 个月时，接受 SH 修复的患者的术后疼痛评分高于接受 PH 修复的患者（3.5 ± 0.4 对 1.8 ± 0.4；P < 0.05）。SH 组中有更多的慢性疼痛问题（26%对 5%；P = 0.0003）和较低的满意度评分（7.5 ± 0.3 对 8.6 ± 0.3；P < 0.05）。总体而言，活动评估量表评分没有显著差异。
我们的数据表明 PH 和 SH 是不同的。SH 的 LVHR 与复发率增加、术后疼痛评分增加、慢性疼痛问题和患者满意度降低有关。我们建议未来的研究将 PH 的 LVHR 与 SH 的 LVHR 分开评估。
