Kao Angela M, Huntington Ciara R, Otero Javier, Prasad Tanushree, Augenstein Vedra A, Lincourt Amy E, Colavita Paul D, Heniford Brant Todd
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
J Surg Res. 2018 Dec;232:497-502. doi: 10.1016/j.jss.2018.07.034. Epub 2018 Aug 2.
Emergent repairs of incarcerated and strangulated ventral hernia repairs (VHR) are associated with higher perioperative morbidity and mortality than those repaired electively. Despite increasing utilization of minimally invasive techniques in elective repairs, the role for laparoscopy in emergent VHR is not well defined, and its feasibility has been demonstrated only in single center studies.
The American College of Surgeons National Surgical Quality Improvement Program database (2009-2016) was queried for emergent VHR. Laparoscopic and open techniques were compared using univariate and multivariate analyses.
A total of 11,075 patients who underwent emergent ventral and incisional hernia repairs were identified: 85.5% open ventral hernia repair (OVHR), 14.5% laparoscopic ventral hernia repair (LVHR). Patients who underwent emergent OVHRs were older, more comorbid, and more likely to be septic at the time of surgery than those undergoing emergent LVHRs. Emergent OVHR patients were more likely to have minor complications (22.1% versus 11.0%; OR 1.7; 95% CI 1.069-2.834). After controlling for confounding variables, LVHR and OVHR had similar outcomes, with the exception of higher rates of superficial surgical site infection in OVHR (5.0% versus 1.8%; odd's ratio (OR) 2.7; 95% confidence interval (CI) 1.176-6.138). Following multivariate analysis, laparoscopic approach demonstrated similar outcomes in major complications, reoperation, and 30-d mortality compared to open repairs. However, when controlling for other confounding factors, LVHR had reduced length of stay compared to OVHR (6.7 versus 4.0 d; 1.6 d longer, standard error 0.77, P < 0.03).
Emergent LVHR is associated with fewer superficial surgical site infection and shorter length of stay than OVHR but no difference in major complications, reoperation or 30-d mortality is associated with LVHR in the emergency setting.
与择期修补相比，急诊修补嵌顿性和绞窄性腹疝（VHR）的围手术期发病率和死亡率更高。尽管微创技术在择期修补中的应用日益增加，但腹腔镜在急诊VHR中的作用尚不明确，其可行性仅在单中心研究中得到证实。
查询美国外科医师学会国家外科质量改进计划数据库（2009 - 2016年）中的急诊VHR病例。采用单因素和多因素分析比较腹腔镜和开放手术技术。
共识别出11075例行急诊腹疝和切口疝修补的患者：85.5%为开放腹疝修补（OVHR），14.5%为腹腔镜腹疝修补（LVHR）。与接受急诊LVHR的患者相比，接受急诊OVHR的患者年龄更大，合并症更多，且手术时更可能发生感染。急诊OVHR患者更易出现轻微并发症（22.1%对11.0%；OR 1.7；95%CI 1.069 - 2.834）。在控制混杂变量后，LVHR和OVHR的结果相似，但OVHR的浅表手术部位感染率更高（5.0%对1.8%；比值比（OR）2.7；95%置信区间（CI）1.176 - 6.138）。多因素分析后，与开放修补相比，腹腔镜手术在主要并发症、再次手术和30天死亡率方面显示出相似的结果。然而，在控制其他混杂因素后，LVHR的住院时间比OVHR缩短（6.7天对4.0天；长1.6天，标准误0.77，P < 0.03）。
与OVHR相比，急诊LVHR的浅表手术部位感染更少，住院时间更短，但在急诊情况下，LVHR与主要并发症、再次手术或30天死亡率无差异。
