Keller Patrick, Totten Crystal F, Plymale Margaret A, Lin You Wei, Davenport Daniel L, Roth John Scott
University of Kentucky College of Medicine, Lexington, KY, USA.
Division of General Surgery, University of Kentucky, Lexington, KY, USA.
Surg Endosc. 2021 Jan;35(1):415-422. doi: 10.1007/s00464-020-07377-y. Epub 2020 Feb 6.
Mesh repair of parastomal hernia is widely accepted as superior to non-mesh repair, yet the most favorable surgical approach is a subject of continued debate. The aim of this study was to compare the clinical outcomes of open versus laparoscopic parastomal hernia repair.
An IRB-approved retrospective review was conducted comparing laparoscopic (LPHR) or open (OPHR) parastomal hernia repair performed between 2009 and 2017 at our facilities. Patient demographics, preoperative characteristics, operative details, and clinical outcomes were compared by surgical approach. Subgroup analysis was performed by location of mesh placement. Repair longevity was measured using Kaplan-Meier method and Cox proportional hazards regression. Intention to treat analysis was used for this study based on initial approach to the repair.
Sixty-two patients (average age of 61 years) underwent repair (31 LPHR, 31 OPHR). Patient age, gender, BMI, ASA Class, and comorbidity status were similar between OPHR and LPHR. Stoma relocation was more common in OPHR (32% vs 7%, p = .022). Open sublay subgroup was similar to LPHR in terms of wound class and relocation. Open "Other" and Sublay subgroups resulted in more wound complications compared to LPHR (70% and 48% vs 27%, p = .036). Operative duration and hospital length of stay were less with LPHR (p < .001). After adjustment for prior hernia repair, risk of recurrence was higher for OPHR (p = .022) and Open Sublay and Other subgroups compared to LPHR (p = .005 and p = .027, respectively).
Laparoscopic repair of parastomal hernias is associated with shorter operative duration, decreased length of stay, fewer short-term wound complications, and increased longevity of repair compared to open repairs. Direct comparison of repair longevity between LPHR and OPHR with mesh using Kaplan-Meier estimate is unique to this study. Further study is warranted to better understand methods of parastomal hernia repair associated with fewer complications and increased durability.
造口旁疝的补片修补术被广泛认为优于非补片修补术，但最有利的手术方法仍是一个持续争论的话题。本研究的目的是比较开放与腹腔镜造口旁疝修补术的临床结果。
进行了一项经机构审查委员会批准的回顾性研究，比较了2009年至2017年在我们机构进行的腹腔镜（LPHR）或开放（OPHR）造口旁疝修补术。通过手术方式比较患者人口统计学、术前特征、手术细节和临床结果。按补片放置位置进行亚组分析。使用Kaplan-Meier方法和Cox比例风险回归测量修补的持久性。基于最初的修补方法，本研究采用意向性分析。
62例患者（平均年龄61岁）接受了修补术（31例LPHR，31例OPHR）。OPHR组和LPHR组患者的年龄、性别、BMI、美国麻醉医师协会分级和合并症状况相似。造口重新定位在OPHR组中更常见（32%对7%，p = 0.022）。开放肌下补片亚组在伤口分级和重新定位方面与LPHR组相似。与LPHR组相比，开放“其他”和肌下补片亚组导致更多伤口并发症（分别为70%和48%对27%，p = 0.036）。LPHR组的手术时间和住院时间更短（p < 0.001）。在调整先前的疝修补术后，OPHR组（p = 0.022）以及开放肌下补片和其他亚组与LPHR组相比复发风险更高（分别为p = 0.005和p = 0.027）。
与开放修补术相比，腹腔镜造口旁疝修补术手术时间更短、住院时间缩短、短期伤口并发症更少且修补持久性增加。本研究独特之处在于使用Kaplan-Meier估计对LPHR和使用补片的OPHR之间的修补持久性进行直接比较。有必要进行进一步研究以更好地了解与更少并发症和更高耐用性相关的造口旁疝修补方法。
