Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 100, Annapolis, MD, 21401, USA.
Surg Endosc. 2021 Oct;35(10):5593-5598. doi: 10.1007/s00464-020-08060-y. Epub 2020 Oct 9.
The hybrid approach to abdominal wall reconstruction (AWR) for abdominal wall hernias combines minimally invasive posterior component separation and retromuscular dissection with open fascial closure and mesh implantation. This combination may enhance patient outcomes and recovery compared to the open approach alone. The purpose of this study is to evaluate the operative outcomes of hybrid vs. open abdominal wall reconstruction.
A retrospective review was conducted to compare patients who underwent open versus hybrid AWR between September 2015 and August of 2018 at Anne Arundel Medical Center. Patient demographics and perioperative data were collected and analyzed using univariate analysis.
Sixty-five patients were included in the final analysis: 10 in the hybrid and 55 in the open groups. Mean age was higher in the hybrid vs. open group (65.1 vs. 56.2 years, p < 0.05). The hybrid and open groups were statistically similar (p > 0.05) in gender distribution, mean BMI, and ASA score. Intraoperative comparison found hybrid patients parallel to open patients (p > 0.05) in mean operative time (294.5 vs. 267.5 min), defect size (14.4 vs. 13.6 cm), mesh area, and drain placement. The mean total hospital cost was lower in the hybrid group compared to the open group ($16,426 vs. $19,054, p = 0.43). The hybrid group had a shorter length of stay (5.3 vs. 3.6 days, p = 0.03) after surgery and was followed for a similar length of time (12.3 vs. 12.6 months, p = 0.91). The hybrid group showed a lower trend of seroma, hematoma, wound infection, ileus, and readmission rates after surgery.
A review of patient outcomes after hybrid AWR highlights a trend towards shorter length of stay, lower hospital cost, and fewer complications without significant addition to operative time. Long-term studies on a larger number of patients are definitively needed to characterize the comprehensive benefits of this approach.
腹壁疝的腹壁重建（AWR）混合方法将微创后部分离和肌后解剖与开放式筋膜闭合和网片植入相结合。与单独开放方法相比，这种组合可能会改善患者的预后和恢复。本研究旨在评估混合与开放腹壁重建的手术结果。
回顾性分析 2015 年 9 月至 2018 年 8 月在安妮阿伦德尔医疗中心接受开放与混合 AWR 的患者。使用单变量分析收集和分析患者的人口统计学和围手术期数据。
最终分析包括 65 例患者：10 例混合组和 55 例开放组。混合组的平均年龄高于开放组（65.1 岁比 56.2 岁，p<0.05）。混合组和开放组在性别分布、平均 BMI 和 ASA 评分方面统计学相似（p>0.05）。术中比较发现，混合组与开放组的平均手术时间（294.5 分钟比 267.5 分钟）、缺损大小（14.4 厘米比 13.6 厘米）、网片面积和引流管放置相似（p>0.05）。混合组的总住院费用低于开放组（16426 美元比 19054 美元，p=0.43）。术后混合组的住院时间更短（5.3 天比 3.6 天，p=0.03），随访时间相似（12.3 个月比 12.6 个月，p=0.91）。混合组术后血清肿、血肿、感染、肠梗阻和再入院率呈下降趋势。
混合 AWR 后患者结局的回顾突出了住院时间更短、住院费用更低、并发症更少的趋势，而手术时间没有明显增加。需要对更多患者进行长期研究，以明确这种方法的全面益处。
