Schlottmann Francisco, Strassle Paula D, Farrell Timothy M, Patti Marco G
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
J Gastrointest Surg. 2017 May;21(5):778-784. doi: 10.1007/s11605-016-3345-2. Epub 2017 Jan 6.
It is unclear if minimally invasive surgery (MIS) has been universally embraced for paraesophageal hernia (PEH) repair. The aims of this study were: (a) to assess the national utilization of MIS for PEH repair and (b) to compare the perioperative outcomes between MIS and open procedures METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥18 years old) who underwent PEH repair were included. Linear and logistic regression, adjusted for patient and hospital characteristics, were used to assess the effect of minimally invasive surgery on patient outcomes RESULTS: A total of 63,812 patients were included. An abdominal approach was used in 60,087 (94.2%) patients and a thoracic approach in 3725 (5.8%) cases. Between 2000 and 2013, the rate of MIS significantly increased in abdominal and thoracic procedures. Patients undergoing MIS were less likely to experience postoperative infection, bleeding, cardiac failure, renal failure, respiratory failure, shock, and had a lower inpatient mortality. In addition, MIS significantly reduced the length of hospital stay and the overall cost.
MIS is associated with significantly better perioperative outcomes and lower costs. These data strongly support the MIS approach as standard of care for PEH repair.
目前尚不清楚微创手术（MIS）是否已被广泛应用于食管旁疝（PEH）修复。本研究的目的是：（a）评估全国范围内MIS用于PEH修复的情况，以及（b）比较MIS与开放手术的围手术期结果。方法：利用2000 - 2013年全国住院患者样本进行基于人群的回顾性分析。纳入接受PEH修复的成年患者（≥18岁）。采用线性和逻辑回归，并对患者和医院特征进行调整，以评估微创手术对患者预后的影响。结果：共纳入63,812例患者。60,087例（94.2%）患者采用腹部入路，3725例（5.8%）采用胸部入路。2000年至2013年期间，腹部和胸部手术中MIS的使用率显著增加。接受MIS的患者术后发生感染、出血、心力衰竭、肾衰竭、呼吸衰竭、休克的可能性较小，住院死亡率也较低。此外，MIS显著缩短了住院时间并降低了总体费用。结论：MIS与显著更好的围手术期结果和更低的成本相关。这些数据有力地支持了将MIS方法作为PEH修复的护理标准。
