Drissi F, Jurczak F, Cossa J P, Gillion J F, Baayen C
Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Hôtel Dieu, CHU Nantes, Place Ricordeau, 44093, Nantes Cedex 1, France.
Chirurgie générale et Digestive, Clinique Mutualiste de l'Estuaire, Cité sanitaire, 11 boulevard Georges Charpak, 44606, Saint Nazaire, France.
Hernia. 2018 Jun;22(3):427-435. doi: 10.1007/s10029-017-1689-5. Epub 2017 Oct 27.
Groin hernia repair (GHR) is one of the most frequent surgical interventions practiced worldwide. Outpatient surgery for GHR is known to be safe and effective.
To assess the outpatient practice for GHR in France and identify predictive factors of failure.
Forty one surgeons of the French "Club Hernie" prospectively gathered data concerning successive GHR over a period of 4 years within a multicenter database.
A total of 9330 patients were operated on during the period of the study. Mean age was 61.8 (1-100) years old and 8245 patients (88.4%) were males. 6974 GHR (74.7%) were performed as outpatient procedures. In 262 patients (3.6%), the outpatient setting, previously selected, did not succeed. Upon multivariate analysis, predictive factors of ambulatory failure were ASA grade ≥ III (OR 0.42, p < 0.001), bilateral GHR (OR 0.47, p < 0.001), emergency surgery for incarcerated hernia (OR 0.10, p < 0.001), spinal anesthesia (OR 0.27, p < 0.001) and occurrence of an early post-operative complication (OR 0.07, p < 0.001). The more frequent complications were acute urinary retention and surgical site collections. 2094 patients (21.5%) were not selected preoperatively for 1-day surgery.
More than 74% of the patients benefited from outpatient surgery for GHR with a poor failure rate. Predictive factors of outpatient GHR failure were ASA grade ≥ III, bilateral GHR, emergency surgery for incarcerated hernia, spinal anesthesia and occurrence of an early post-operative complication. Ambulatory failures were often related to social issues or medical complications. Outpatient surgery criteria could become less restrictive in the future.
腹股沟疝修补术（GHR）是全球最常见的外科手术之一。已知GHR门诊手术是安全有效的。
评估法国GHR的门诊手术情况并确定失败的预测因素。
法国“疝俱乐部”的41位外科医生在一个多中心数据库中前瞻性地收集了4年内连续进行GHR手术的数据。
在研究期间共对9330例患者进行了手术。平均年龄为61.8岁（1 - 100岁），8245例患者（88.4%）为男性。6974例GHR（74.7%）作为门诊手术进行。在262例患者（3.6%）中，之前选择的门诊手术未成功。多因素分析显示，门诊手术失败的预测因素为美国麻醉医师协会（ASA）分级≥III级（比值比[OR]0.42，p < 0.001）、双侧GHR（OR 0.47，p < 0.001）、嵌顿疝急诊手术（OR 0.10，p < 0.001）、脊髓麻醉（OR 0.27，p < 0.001）以及术后早期并发症的发生（OR 0.07，p < 0.001）。较常见的并发症是急性尿潴留和手术部位积液。2094例患者（21.5%）术前未被选择进行日间手术。
超过74%的患者受益于GHR门诊手术，失败率较低。门诊GHR失败的预测因素为ASA分级≥III级、双侧GHR、嵌顿疝急诊手术、脊髓麻醉以及术后早期并发症的发生。门诊手术失败通常与社会问题或医疗并发症有关。未来门诊手术标准可能会放宽。
