Wexner Medical Center Department of General and Gastrointestinal Surgery, The Ohio State University, Columbus, USA.
Vanderbilt University Medical Center, Nashville, USA.
Surg Endosc. 2021 Jan;35(1):241-248. doi: 10.1007/s00464-020-07386-x. Epub 2020 Jan 28.
Robotic-assisted retromuscular repairs reduce length of stay compared to open surgery. However, no study has evaluated the long-term impact on abdominal core quality of life.
Retrospective cohort study performed using prospectively collected data from the Americas Hernia Society Quality Collaborative (AHSQC) including adults who underwent open or robotic-assisted retromuscular, incisional hernia repair between 2013 and 2019. Differences in Hernia-Related Quality of Life Survey (HerQLes) scores at baseline and 1 year postoperatively were compared using multivariable regression models. Secondary outcomes included perioperative complications, wound morbidity, and hernia recurrence.
236 patients underwent open (N = 194) and robotic (N = 42) repairs. Median age was 61 years. The open group had larger hernia widths (median [IQR], 13 [9-16] vs. 7 [5-9] cm) and longer LOS (5 [4-6] vs. 1.5 [1-3] days). Median HerQLes summary scores at 1 year were similar at 88 [67, 93] points for open vs 90 [58, 94] for robotic arm. Wound morbidity rates were similar. On multivariate analysis, there was no difference in HerQLes summary score improvement 1 year after repair between techniques (3.3, CI [- 7.7, 14.3]; p = 0.52), however, patients with a comparatively larger hernia width of 7 cm had a 5.9 (CI [1.1, 10.8], p = 0.02) increase in HerQLes scores, and patients with a higher ASA class (3-5) saw an 11-point score improvement (CI [2.2, 20.0], p = 0.02) regardless of approach. Smoking, BMI above 30, or hernia recurrence had no significant impact, while COPD hindered scores (- 17.0, CI [- 32.3, - 1.7], p = 0.03).
Improvement in abdominal core quality of life after repair is comparable between open and robotic retromuscular techniques. Larger hernia defects and higher ASA class patients benefitted the greatest. Robotic approaches offer shorter LOS with comparable recurrence and wound morbidity rates 1 year after surgery. The surgical approach should be personalized and guided by the surgeon's individual and institutional expertise.
与开放式手术相比，机器人辅助的后肌膜修复可缩短住院时间。然而，尚无研究评估其对腹部核心生活质量的长期影响。
本研究采用前瞻性收集的美洲疝学会质量协作组（AHSQC）数据进行回顾性队列研究，纳入 2013 年至 2019 年间接受开放式或机器人辅助后肌膜、切口疝修复的成年人。使用多变量回归模型比较基线和术后 1 年时疝相关生活质量调查（HerQLes）评分的差异。次要结局包括围手术期并发症、伤口发病率和疝复发。
236 例患者接受了开放式（N=194）和机器人式（N=42）修复。中位年龄为 61 岁。开放式组的疝宽度更大（中位数[IQR]，13[9-16]cm 比 7[5-9]cm），住院时间更长（5[4-6]d 比 1.5[1-3]d）。开放式组和机器人组在术后 1 年的 HerQLes 综合评分相似，分别为 88[67，93]分和 90[58，94]分。伤口发病率相似。多变量分析显示，两种技术在术后 1 年的 HerQLes 综合评分改善方面无差异（3.3，CI[-7.7，14.3]；p=0.52），然而，疝宽度为 7cm 的患者 HerQLes 评分增加 5.9（CI[1.1，10.8]，p=0.02），ASA 分级较高（3-5）的患者评分提高 11 分（CI[2.2，20.0]，p=0.02），无论手术方式如何。吸烟、BMI 超过 30 或疝复发均无显著影响，而 COPD 则降低评分（-17.0，CI[-32.3，-1.7]，p=0.03）。
开放式和机器人辅助后肌膜修复后腹部核心生活质量的改善相当。较大的疝缺损和较高的 ASA 分级患者获益最大。机器人方法可缩短住院时间，术后 1 年复发和伤口发病率相似。手术方法应根据外科医生的个人和机构专业知识进行个性化和指导。
