Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark2Danish Hernia Database, Copenhagen, Denmark.
Danish Hernia Database, Copenhagen, Denmark3Department of Gastroenterology, Surgical Section, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
JAMA Surg. 2014 Aug;149(8):853-7. doi: 10.1001/jamasurg.2014.177.
In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many different approaches reflects a rather low level of evidence for the best method of repair. Randomized clinical trials are lacking. Large, prospective cohort studies are an alternative way of acquiring improved evidence regarding the best type of repair.
To investigate the reoperation rate after laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database.
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed.
Repair of a femoral hernia.
Reoperation for a femoral hernia.
A total of 3970 primary femoral hernia repairs were analyzed; 27.3% occurred in men. There were 2413 elective repairs (60.8%) and 1557 emergency procedures (39.2%). In a multivariate analysis, laparoscopic repair was found to result in reduced risk of reoperation (hazard ratio, 0.33; 95% CI, 0.09-0.95) compared with open repair. The risk of reoperation was higher in women (hazard ratio, 1.95; 95% CI, 1.10-3.45). Furthermore, the laparoscopic approach seemed to reduce the risk of subsequent occurrence of an inguinal hernia in the same groin.
Laparoscopic repair of a femoral hernia reduces the risk of reoperation for a recurrence compared with open repair. The results from this study support the guidelines recommending the use of the laparoscopic approach for repair of femoral hernias.
在丹麦，每年大约有 10000 例腹股沟疝需要修复，其中 2%至 4%为股疝。股疝的修复方法有多种，包括缝合修复和不同类型的网片修复，采用开放或腹腔镜技术。使用如此多的不同方法反映出最佳修复方法的证据水平相当低。目前缺乏随机临床试验。大型前瞻性队列研究是获得最佳修复类型证据的另一种方法。
通过全国数据库分析，调查腹腔镜与开放式股疝修补术后再次手术的比率。
设计、设置和参与者：进行了一项前瞻性队列研究。从 1998 年 1 月至 2012 年 2 月，从丹麦疝数据库中提取并分析了股疝修复的数据。数据库中对所有的修复手术进行了随访，并对再次手术的报告进行了分析，这被用作复发的替代指标。分析了指数修复后的股疝复发和腹股沟疝发生情况。
股疝修复术。
股疝再次手术。
共分析了 3970 例原发性股疝修复，其中 27.3%发生在男性。其中择期手术 2413 例（60.8%），急诊手术 1557 例（39.2%）。多变量分析显示，与开放式修复相比，腹腔镜修复可降低再次手术的风险（风险比，0.33；95%CI，0.09-0.95）。女性的再次手术风险较高（风险比，1.95；95%CI，1.10-3.45）。此外，腹腔镜方法似乎降低了同一腹股沟发生腹股沟疝的风险。
与开放式修复相比，腹腔镜股疝修复可降低复发再次手术的风险。本研究结果支持推荐使用腹腔镜方法修复股疝的指南。
