Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore.
Duke-National University of Singapore Medical School, Singapore, Singapore.
Surg Endosc. 2022 Jan;36(1):591-597. doi: 10.1007/s00464-021-08321-4. Epub 2021 Feb 10.
The presence of previous abdominal surgery (PAS) has traditionally been considered to add difficulty to and increase risk of complications of laparoscopic procedures. This study aims to analyse the impact of non-liver-related PAS on the difficulty of minimally invasive liver resections (MILRs).
After exclusion of patients with concomitant major surgical procedures as well as previous liver resections, 515 consecutive patients undergoing MILR in Singapore General Hospital from 2006 to 2019 were analysed, consisting of 161 MILR in patients with previous abdominal surgery (WPAS) and 354 MILR in patients without previous abdominal surgery (WOPAS). Propensity score-matched (PSM) comparison was performed between WPAS and WOPAS groups. In addition, subgroup analysis was made comparing previous upper or lower abdominal surgery and open versus minimally invasive approach of PAS. Outcomes measured include those associated with operative difficulty such as open conversion rates, operative time, blood loss, as well as morbidity and mortality rates.
MILR outcomes in patients WPAS are not inferior to those WOPAS. Overall open conversion rate was 8.2%, higher in patients WOPAS compared to patients WPAS (11.9% versus 3.5%, p = 0.015). Operating time (p = 0.942), blood loss (p = 0.063), intraoperative blood transfusion (p = 0.750), length of hospital stay (p = 0.206), morbidity (p = 0.217) and 30- and 90-day mortality (p = 1 & p = 0.367) were comparable between the two groups and subgroup analysis.
Outcomes of MILR in patients with previous non-liver-related abdominal surgery are not inferior to patients without previous abdominal surgery.
既往腹部手术（PAS）的存在传统上被认为会增加腹腔镜手术的难度并增加并发症的风险。本研究旨在分析非肝脏相关 PAS 对微创肝切除术（MILR）难度的影响。
排除合并主要手术以及既往肝切除术的患者后，分析了 2006 年至 2019 年在新加坡总医院接受 MILR 的 515 例连续患者，其中 161 例既往腹部手术（WPAS）患者和 354 例无既往腹部手术（WOPAS）患者。WPAS 和 WOPAS 组之间进行了倾向评分匹配（PSM）比较。此外，还进行了亚组分析，比较了既往上腹部或下腹部手术以及 PAS 的开放与微创入路。测量的结果包括与手术难度相关的结果，如中转开腹率、手术时间、出血量以及发病率和死亡率。
WPAS 患者的 MILR 结果并不逊于 WOPAS 患者。总体中转开腹率为 8.2%，WOPAS 患者高于 WPAS 患者（11.9%比 3.5%，p=0.015）。手术时间（p=0.942）、出血量（p=0.063）、术中输血（p=0.750）、住院时间（p=0.206）、发病率（p=0.217）以及 30 天和 90 天死亡率（p=1 和 p=0.367）在两组和亚组分析中均无差异。
既往非肝脏相关腹部手术患者的 MILR 结果并不逊于无既往腹部手术史的患者。
