Sharma G, Boules M, Punchai S, Strong A, Froylich D, Zubaidah N H, O'Rourke C, Brethauer S A, Rodriguez J, El-Hayek K, Kroh M
Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA.
Surg Endosc. 2017 Apr;31(4):1573-1582. doi: 10.1007/s00464-016-5143-z. Epub 2016 Aug 5.
Currently there is no consensus on management of ventral hernias encountered during bariatric surgery (BS). This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during BS at our institution.
Patients who had concomitant VHR during BS from 2004 to 2015 were identified. Data collected included baseline demographics, comorbidities, perioperative parameters, surgical approach and postoperative outcomes.
A total of 159 patients underwent concomitant VHR during the study period at the time of BS. One hundred and one (64 %) patients were female; median age was 53 years (IQR 45.0-60.3) and median BMI was 48.2 kg/m (IQR 41.6-54.1). Comorbidities included: hypertension (n = 124, 78 %), type 2 diabetes (n = 103, 65 %), hyperlipidemia (n = 100, 63 %), obstructive sleep apnea (n = 98, 62 %) and reflux disease (n = 54, 34 %). Out of 159 patients, 41 patients (26 %) had a prior VHR. Out of 103 patients, 69 patients (67 %) had a previous abdominal surgery. Of the concomitant VHR, 144 (91 %) were completed laparoscopically, 12 (7 %) patients were converted to open surgery and 3 (2 %) patients underwent primary open procedures. Technique included primary suture closure in 115 (72 %) and mesh repair in 44. Early postoperative complications (<30 days) were reported in 16 (10 %) patients, with superficial wound infection (n = 9), bowel obstruction (n = 2), marginal ulcer (n = 2), DVT (n = 1) and pneumonia (n = 1). Hernia recurrence was reported in 3 patients (2 %) in the early post-op period and in 40 patients (25 %) as a late (>30 days) complication. Surgery for recurrent hernia was performed in 31/42 patients during follow-up. At 12-month follow-up, median BMI and % excess weight loss were 34.2 kg/m (IQR 29.5-40.9) and 59.6 % (IQR 44.9-74.8 %), respectively.
Ventral hernia is a common finding in patients undergoing BS. Both primary suture repair and mesh repair result in acceptable results, both in terms of recurrence and perioperative complications.
目前，对于减重手术（BS）中遇到的腹疝管理尚无共识。本研究旨在评估我院在减重手术期间同期进行腹疝修补术（VHR）的发生率和结果。
确定2004年至2015年期间在减重手术时同期进行VHR的患者。收集的数据包括基线人口统计学、合并症、围手术期参数、手术方式和术后结果。
在研究期间，共有159例患者在减重手术时同期进行了VHR。101例（64%）患者为女性；中位年龄为53岁（四分位间距45.0 - 60.3），中位体重指数为48.2kg/m²（四分位间距41.6 - 54.1）。合并症包括：高血压（n = 124，78%）、2型糖尿病（n = 103，65%）、高脂血症（n = 100，63%）、阻塞性睡眠呼吸暂停（n = 98，62%）和反流性疾病（n = 54，34%）。159例患者中（26%）有41例曾接受过VHR。103例患者中，69例（67%）曾接受过腹部手术。在同期进行的VHR中，144例（91%）通过腹腔镜完成，12例（7%）患者转为开放手术，3例（2%）患者接受一期开放手术。技术包括115例（72%）的一期缝合关闭和44例的补片修补。术后早期并发症（<30天）在16例（10%）患者中报告，包括浅表伤口感染（n = 9）、肠梗阻（n = 2）、边缘溃疡（n = 2）、深静脉血栓形成（n = 1）和肺炎（n = 1）。术后早期有3例（2%）患者报告疝复发，作为晚期（>30天）并发症有40例（25%）。随访期间，42例复发疝患者中有31例接受了手术。在12个月随访时，中位体重指数和超重减轻百分比分别为34.2kg/m²（四分位间距29.5 - 40.9）和59.6%（四分位间距44.9 - 74.8%）。
腹疝在接受减重手术的患者中很常见。一期缝合修补和补片修补在复发率和围手术期并发症方面均取得了可接受的结果。
