Department of Surgery, Cleveland Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Surg Endosc. 2017 Nov;31(11):4425-4430. doi: 10.1007/s00464-017-5492-2. Epub 2017 Mar 24.
Ventral hernia repair (VHR) is a frequent problem in the expanding aging population. However, advanced age is often viewed as a contraindication to elective hernia surgery. We aimed to analyze outcomes of VHR in a large cohort of elderly patients. We hypothesized that elective VHR is safe and effective even in patients over 70 years old.
We conducted a retrospective review of consecutive patients over the age of 70 who underwent VHR at a at a tertiary care hospital. Main outcome measures included postoperative complications and recurrence rate.
Between 2006 and 2015, 263 elderly patients who underwent elective VHR were included. Major comorbidities included diabetes, COPD, and smoking history. The majority of the patients underwent open repairs. Surgical site events occurred in 54 patients (21%). Postoperative complications included 17 venous thromboembolism occurrences, 2 myocardial infarctions, 41 patients who required postoperative critical care, and 1 mortality. Readmission within 90 days postoperatively occurred in 34 patients (13%). At a mean follow-up of 25.6 months, 17 patients in the open group and 6 patients in the laparoscopic group had a recurrence.
We demonstrated that VHR can be performed reasonably safely and effectively even in this potentially risky cohort. The use of laparoscopy might be associated with further reduction in morbidity. Overall, age should not be a contraindication to elective VHR, even in patients over 70 years old.
腹疝修补术（VHR）是老龄化人口不断增加所带来的常见问题。然而，高龄通常被视为择期疝手术的禁忌症。我们旨在分析大量老年患者的 VHR 结果。我们假设，即使是 70 岁以上的患者，择期 VHR 也是安全有效的。
我们对在一家三级护理医院接受 VHR 的 70 岁以上的连续患者进行了回顾性研究。主要观察指标包括术后并发症和复发率。
在 2006 年至 2015 年间，我们纳入了 263 名接受择期 VHR 的老年患者。主要合并症包括糖尿病、COPD 和吸烟史。大多数患者接受了开放式修复。54 例患者（21%）发生手术部位事件。术后并发症包括 17 例静脉血栓栓塞事件、2 例心肌梗死、41 例需要术后重症监护和 1 例死亡。术后 90 天内再入院的患者有 34 例（13%）。在平均随访 25.6 个月时，开放组中有 17 例和腹腔镜组中有 6 例患者复发。
我们表明，即使在这个潜在高风险的患者群体中，VHR 也可以合理地安全且有效地进行。腹腔镜的使用可能与进一步降低发病率相关。总体而言，即使是 70 岁以上的患者，年龄也不应成为择期 VHR 的禁忌症。
