Kokotovic D, Sjølander H, Gögenur I, Helgstrand F
Department of Surgery, Køge Hospital, University of Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.
Hernia. 2016 Apr;20(2):281-7. doi: 10.1007/s10029-016-1464-z. Epub 2016 Feb 2.
Due to risks of postoperative morbidity and recurrence some patients with a ventral hernia are not offered surgical repair. There is limited data on the rate and consequences of a watchful waiting (WW) strategy for these patients. The objective of this cohort study was to analyse outcomes for patients with a ventral hernia who underwent watchful waiting, in terms of later requirement for hernia repair.
All patients (≥18 years) electively referred to our out-patient clinic from 1 January 2009 to 1 July 2014 with incisional, umbilical or epigastric hernia were included. Information on patient characteristics and whether patients underwent WW or surgery was obtained from hospital files and the Danish National Patient Register. A 100% follow-up was obtained.
The analyses comprised 569 patients with incisional hernia (WW = 58.1%) and 789 patients with umbilical/epigastric hernia (WW = 43.2%). Kaplan-Meier analyses estimated that the probability for patients who underwent watchful waiting to receive later surgical repair was 19 for incisional hernias and 16% for umbilical/epigastric hernias after 5 years. The probability of requiring emergency repair when in the WW group was 4% for both incisional and umbilical/epigastric hernias after 5 years. There were no significant differences in 30-day readmission, reoperation or mortality rates between the WW patients who later underwent elective hernia repair and patients who were initially offered surgery (p > 0.05), for both incisional and umbilical/epigastric hernias.
Watchful waiting appears to be a safe strategy in the treatment of incisional, umbilical and epigastric hernias.
由于存在术后发病和复发风险，一些腹疝患者未接受手术修复。关于这些患者采用观察等待（WW）策略的发生率及后果的数据有限。本队列研究的目的是分析接受观察等待的腹疝患者在后期疝气修复需求方面的结局。
纳入2009年1月1日至2014年7月1日期间择期转诊至我院门诊的所有（≥18岁）有切口疝、脐疝或上腹疝的患者。从医院档案和丹麦国家患者登记处获取患者特征信息以及患者是否接受观察等待或手术的信息。随访率为100%。
分析包括569例切口疝患者（观察等待组占58.1%）和789例脐疝/上腹疝患者（观察等待组占43.2%）。Kaplan-Meier分析估计，接受观察等待的患者在5年后接受后期手术修复的概率，切口疝为19%，脐疝/上腹疝为16%。观察等待组患者在5年后因切口疝和脐疝/上腹疝需要急诊修复的概率均为4%。后期接受择期疝气修复的观察等待患者与最初接受手术的患者相比，在30天再入院率、再次手术率或死亡率方面无显著差异（p>0.05），无论是切口疝还是脐疝/上腹疝。
观察等待似乎是治疗切口疝、脐疝和上腹疝的一种安全策略。
