Zettervall Sara L, Amdur Richard, Vaziri Khashayar
Department of Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC.
Surg Laparosc Endosc Percutan Tech. 2015 Dec;25(6):496-9. doi: 10.1097/SLE.0000000000000205.
Prolonged operative time (ORT) is a drawback of laparoscopic bariatric surgery due to concerns for increased morbidity. This study aims to identify the ORT when open procedures are superior to laparoscopic procedures.
Thirty-day outcomes for bariatric procedures in the NSQIP database were analyzed comparing laparoscopic ORT to equal or shorter open ORT. Multivariate regression was utilized to control for patient demographics and comorbidities.
Among 48,274 cases, laparoscopic procedures reduced morbidity and mortality compared with open procedures of similar ORT. Laparoscopic procedures ≤3 hours were equal or superior to shorter open procedures. Laparoscopic procedures >6 hours had worse outcomes than open operations <3 hours. Open operations >3 hours had no benefit regardless of ORT.
Laparoscopic bariatric operations have less mortality and morbidity compared with open procedures of similar ORT. The advantages of laparoscopic procedures are eliminated when ORT exceeds 6 hours compared with shorter open procedures.
由于担心发病率增加，手术时间延长（ORT）是腹腔镜减肥手术的一个缺点。本研究旨在确定开放手术优于腹腔镜手术时的ORT。
分析NSQIP数据库中减肥手术的30天结果，将腹腔镜ORT与相等或更短的开放ORT进行比较。采用多变量回归来控制患者人口统计学和合并症。
在48274例病例中，与ORT相似的开放手术相比，腹腔镜手术降低了发病率和死亡率。ORT≤3小时的腹腔镜手术与更短的开放手术效果相当或更优。ORT>6小时的腹腔镜手术比开放手术<3小时的效果更差。无论ORT如何，开放手术>3小时均无益处。
与ORT相似的开放手术相比，腹腔镜减肥手术的死亡率和发病率更低。与更短的开放手术相比，当ORT超过6小时时，腹腔镜手术的优势就消失了。
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