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增强型完全腹膜外(eTEP)Rives-Stoppa 修补术治疗切口疝和原发性腹疝后生活质量、术后并发症和疝复发。

Quality of life, post-operative complications, and hernia recurrence following enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa for incisional and primary ventral hernia repair.

机构信息

Department of General Surgery, Assuta Ashdod Public Hospital, Affiliated with Faculty of Health and Science and Ben-Gurion University, Ha-Refu'a St 7, Ashdod, Israel.

Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, Derech Sheba 2, 52662, Ramat-Gan, Israel.

出版信息

Updates Surg. 2023 Oct;75(7):1971-1978. doi: 10.1007/s13304-023-01572-x. Epub 2023 Jun 28.

Abstract

The purpose of this study was to evaluate the quality of life (QoL), early post-operative complications, and hernia recurrence rate following laparoscopic enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa (RS) for incisional and primary ventral hernia repair. Retrospective review of a prospectively maintained database of all patients undergoing eTEP-RS between 2017 and 2020. Data retrieved included demographics, and clinical and operative variables. QoL was assessed using the EuraHS-QoL scale prior to- and following eTEP-RS. During the study period, 61 patients met the inclusion criteria. Age and BMI were 62 (60.4 ± 13.8) years and 29.7 (30.4 ± 6) kg/m, respectively. Incisional hernia was the most common pathology (n = 40, 65%) followed by primary ventral hernia (n = 21, 35%), with 24 patients (39%) having a previous hernia repair. Diastasis-recti repair was undertaken in 34 patients (55%), a concomitant inguinal hernia was repaired in 6 patients (10%), and 13 patients (21%) underwent transversus abdominis release (TAR). Median follow-up time was 13 months and 15 patients (25%) had at least 2 years of follow-up. Hernia recurrence was found in 4 patients (6.5%). Pre-operative and post-operative EuraHS-QOL questionnaire scores were available for 46 patients (75%) and showed significant improvement in pain (7 vs. 0.5, p < 0.0001; 5 vs. 0.5, p < 0.0001; 5 vs. 1.5; p < 0.006), restrictions (median of 5 vs. 0.5, p < 0.0001; 5 vs. 0, p < 0.0001; median of 5 vs. 1, p < 0.0001, of 6.5 vs. 1.5, p < 0.0001), and cosmetic appearance (8 vs. 4, p < 0.0001). Abdominal wall repair using the eTEP-RS approach significantly improves subjective QoL variables with an acceptable post-operative complications and hernia recurrence rates in a short-term follow-up.

摘要

本研究旨在评估腹腔镜增强型完全腹膜外(eTEP)Rives-Stoppa(RS)修复切口和原发性腹侧疝后患者的生活质量(QoL)、早期术后并发症和疝复发率。回顾性分析了 2017 年至 2020 年间所有接受 eTEP-RS 治疗的患者的前瞻性维护数据库中的数据。数据包括人口统计学、临床和手术变量。在接受 eTEP-RS 治疗之前和之后,使用 EuraHS-QoL 量表评估 QoL。在研究期间,61 名患者符合纳入标准。年龄和 BMI 分别为 62(60.4±13.8)岁和 29.7(30.4±6)kg/m2。切口疝是最常见的病理类型(n=40,65%),其次是原发性腹侧疝(n=21,35%),其中 24 例(39%)有过疝修补史。34 例(55%)行腹直肌分离修复,6 例(10%)同期行腹股沟疝修补,13 例(21%)行腹横肌松解术(TAR)。中位随访时间为 13 个月,15 例(25%)至少随访 2 年。4 例(6.5%)患者出现疝复发。46 例患者(75%)有术前和术后 EuraHS-QOL 问卷评分,显示疼痛显著改善(7 分比 0.5 分,p<0.0001;5 分比 0.5 分,p<0.0001;5 分比 1.5 分,p<0.006)、限制(中位数 5 分比 0.5 分,p<0.0001;5 分比 0 分,p<0.0001;中位数 5 分比 1 分,p<0.0001;中位数 6.5 分比 1.5 分,p<0.0001)和美容外观(8 分比 4 分,p<0.0001)。采用 eTEP-RS 方法修复腹壁可显著改善主观 QoL 变量,在短期随访中具有可接受的术后并发症和疝复发率。

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