Holihan Julie L, Flores-Gonzalez Juan R, Mo Jiandi, Ko Tien C, Kao Lillian S, Liang Mike K
University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 5.254, Houston, TX, 77030, USA.
World J Surg. 2017 May;41(5):1267-1273. doi: 10.1007/s00268-016-3859-5.
Little is known about the clinical or patient-reported outcomes with non-operative management of ventral hernias. The aim of this prospective study is to determine the clinical and patient-reported outcomes of patients undergoing initial non-operative treatment of their ventral hernia.
This was a prospective observational study of patients undergoing non-operative management of ventral hernias. Primary outcome was rate of surgical repair of the ventral hernias. Secondary outcomes included rate of emergency repair, elective repair, and emergency room visits. In addition, validated measurement tools for patient satisfaction and cosmetic satisfaction with their abdomen, abdominal pain, and patient function (modified Activities Assessment Scale, AAS) were utilized.
Of 128 patients who underwent non-operative management of a ventral hernia, 99(77.3%) patients were followed for a median (interquartile range) of 12.2(10.4-13.5) months. Twenty (20.2%) patients had at least 1 emergency room visit associated with their hernia. One-quarter (n = 2323.2%) underwent ventral hernia repair following enrollment. Twenty (20.2%) underwent elective repair, and 3 (3.0%) underwent emergent repair. Based on the modified AAS survey, patients who were managed non-operatively experienced no change in patient centered outcomes, while patients converted to operative management had improved scores.
While the short-term risk of emergency surgery with non-operative management of ventral hernias is moderate, the chance of an emergency room visit and surgery is high. Patients who undergo non-operative management of their ventral hernias have no change in patient-reported outcomes at one year, while those converted to operative management experience improvement.
关于腹疝非手术治疗的临床或患者报告结局知之甚少。这项前瞻性研究的目的是确定接受腹疝初始非手术治疗患者的临床和患者报告结局。
这是一项对接受腹疝非手术治疗患者的前瞻性观察性研究。主要结局是腹疝手术修复率。次要结局包括急诊修复率、择期修复率和急诊室就诊率。此外，还使用了经过验证的测量工具来评估患者对腹部的满意度、美容满意度、腹痛情况以及患者功能（改良活动评估量表，AAS）。
在128例接受腹疝非手术治疗的患者中，99例（77.3%）患者的随访时间中位数（四分位间距）为12.2（10.4 - 13.5）个月。20例（20.2%）患者因疝至少有1次急诊室就诊。四分之一（n = 23/23.2%）的患者在入组后接受了腹疝修复。20例（20.2%）接受了择期修复，3例（3.0%）接受了急诊修复。根据改良AAS调查，非手术治疗的患者以患者为中心的结局没有变化，而转为手术治疗的患者得分有所改善。
虽然腹疝非手术治疗的急诊手术短期风险适中，但急诊室就诊和手术的可能性较高。接受腹疝非手术治疗的患者在一年时患者报告结局没有变化，而转为手术治疗的患者则有所改善。
