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腹腔镜治疗复杂食管裂孔疝的体重指数对围手术期结局的影响。

IMPACT OF BODY MASS INDEX ON PERIOPERATIVE OUTCOMES FOR COMPLEX HIATUS HERNIA BY VIDEOLAPAROSCOPY.

机构信息

Universidade Federal do Estado do Rio de Janeiro, Faculty of Medicine and Surgery, Federal Hospital Rio de Janeiro State - Rio de Janeiro (RJ), Brazil.

Fiocruz National Institute of Infectious Diseases, Rio de Janeiro (RJ), Brazil.

出版信息

Arq Bras Cir Dig. 2022 Sep 9;35:e1672. doi: 10.1590/0102-672020220002e1672. eCollection 2022.

Abstract

BACKGROUND

The influence of body mass index on perioperative complications of hiatal hernia surgery is controversial in the surgical literature.

AIMS

The aim of this study was to evaluate the influence of body mass index on perioperative complications and associated risk factors for its occurrence.

METHODS

Two groups were compared on the basis of body mass index: group A with body mass index <32 kg/m2 and group B with body mass index ³32 kg/m2. A multivariate analysis was carried out to identify independent predictors for complications. Complications were classified based on the Clavien-Dindo score.

RESULTS

A total of 49 patients were included in this study, with 30 in group A and 19 in group B. The groups were compared based on factors, such as age, Charlson Comorbidity Index, surgical techniques used, type and location of hiatal hernia, and length of stay. Findings showed that 70% of patients had complex hiatal hernia. In addition, 14 complications also occurred: 7 pleuropulmonary and 7 requiring reoperation. From the seven reoperated, there were three recurrences, two gastrointestinal fistulas, one diaphragmatic hernia, and one incisional hernia. Complications were similar in both the groups, with type IV hiatal hernia being the only independent predictor.

CONCLUSIONS

Body mass index does not affect perioperative complications in anti-reflux surgery and type IV hiatal hernia is an independent predictor of its occurrence.

摘要

背景

体质量指数(BMI)对食管裂孔疝手术围手术期并发症的影响在外科文献中存在争议。

目的

本研究旨在评估 BMI 对围手术期并发症的影响及其发生的相关危险因素。

方法

根据 BMI 将两组进行比较:A 组 BMI<32 kg/m²,B 组 BMI³32 kg/m²。进行多变量分析以确定并发症的独立预测因素。根据 Clavien-Dindo 评分对并发症进行分类。

结果

本研究共纳入 49 例患者,其中 A 组 30 例,B 组 19 例。对两组进行了比较,包括年龄、Charlson 合并症指数、手术技术、食管裂孔疝的类型和位置以及住院时间等因素。结果显示,70%的患者存在复杂食管裂孔疝。此外,还发生了 14 种并发症:7 例肺部并发症和 7 例需要再次手术。在 7 例再次手术中,有 3 例复发,2 例胃肠瘘,1 例膈疝,1 例切口疝。两组并发症相似,只有 IV 型食管裂孔疝是独立的预测因素。

结论

BMI 并不影响抗反流手术的围手术期并发症,而 IV 型食管裂孔疝是其发生的独立预测因素。

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