Froylich Dvir, Haskins Ivy N, Aminian Ali, O'Rourke Colin P, Khorgami Zhamak, Boules Mena, Sharma Gautam, Brethauer Stacy A, Schauer Phillip R, Rosen Michael J
The Bariatric and Metabolic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
The Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Surg Endosc. 2017 Mar;31(3):1305-1310. doi: 10.1007/s00464-016-5112-6. Epub 2016 Jul 21.
The laparoscopic approach to inguinal hernia repair (IHR) has proven beneficial in reducing postoperative pain and facilitating earlier return to normal activity. Except for indications such as recurrent or bilateral inguinal hernias, there remains a paucity of data that specifically identities patient populations that would benefit most from the laparoscopic approach to IHR. Nevertheless, previous experience has shown that obese patients have increased wound morbidity following open surgical procedures. The aim of this study was to investigate the effect of a laparoscopic versus open surgical approach to IHR on early postoperative morbidity and mortality in the obese population using the National Surgical Quality Improvement Program (NSQIP) database.
All IHRs were identified within the NSQIP database from 2005 to 2013. Obesity was defined as a body mass index ≥30 kg/m. A propensity score matching technique between the laparoscopic and open approaches was used. Association of obesity with postoperative outcomes was investigated using an adjusted and unadjusted model based on clinically important preoperative variables identified by the propensity scoring system.
A total of 7346 patients met inclusion criteria; 5573 patients underwent laparoscopic IHR, while 1773 patients underwent open IHR. On univariate analysis, obese patients who underwent laparoscopic IHR were less likely to experience a deep surgical site infection, wound dehiscence, or return to the operating room compared with those who underwent an open IHR. In both the adjusted and unadjusted propensity score models, there was no difference in outcomes between those who underwent laparoscopic versus open IHR.
The laparoscopic approach to IHR in obese patients has similar outcomes as an open approach with regard to 30-day wound events. Preoperative risk stratification of obese patients is important to determining the appropriate surgical approach to IHR. Further studies are needed to investigate the long-term effects of the open and laparoscopic approaches to IHR in the obese population.
腹腔镜腹股沟疝修补术（IHR）已被证明在减轻术后疼痛和促进更早恢复正常活动方面有益。除了复发性或双侧腹股沟疝等适应症外，仍缺乏专门确定最能从腹腔镜IHR方法中受益的患者群体的数据。然而，以往经验表明，肥胖患者在开放手术术后伤口并发症发生率更高。本研究的目的是利用国家外科质量改进计划（NSQIP）数据库，调查腹腔镜与开放手术治疗肥胖人群IHR对术后早期发病率和死亡率的影响。
在NSQIP数据库中识别出2005年至2013年期间所有的IHR病例。肥胖定义为体重指数≥30kg/m²。采用腹腔镜和开放手术方法之间的倾向评分匹配技术。基于倾向评分系统确定的具有临床重要性的术前变量，使用调整和未调整模型研究肥胖与术后结局的关联。
共有7346例患者符合纳入标准；5573例患者接受了腹腔镜IHR，而1773例患者接受了开放IHR。单因素分析显示，与接受开放IHR的患者相比，接受腹腔镜IHR的肥胖患者发生深部手术部位感染、伤口裂开或返回手术室的可能性更小。在调整和未调整的倾向评分模型中，接受腹腔镜与开放IHR的患者结局无差异。
肥胖患者的腹腔镜IHR方法在30天伤口事件方面与开放方法具有相似的结局。肥胖患者的术前风险分层对于确定合适的IHR手术方法很重要。需要进一步研究以调查开放和腹腔镜IHR方法对肥胖人群的长期影响。
