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开放腹疝修补术中Rives-Stoppa和腹横肌松解术后的短期结局及生活质量评估

Short-Term Outcomes and Quality-of-Life Assessment Following Rives-Stoppa and Transversus Abdominis Release Procedures of Open Ventral Hernia Repair.

作者信息

Kumar Rajiv, Prakash Prem, Sinha Seema R, Ahmad Nadeem, Baitha Kanchan S

机构信息

General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, IND.

Biochemistry, Indira Gandhi Institute of Medical Sciences, Patna, IND.

出版信息

Cureus. 2023 Jul 10;15(7):e41637. doi: 10.7759/cureus.41637. eCollection 2023 Jul.

Abstract

INTRODUCTION

Ventral hernia is one of the common surgical conditions that can significantly impact a patient's quality of life (QoL). Open ventral hernia repair using the Rives-Stoppa (RS) and Transversus Abdominis Release (TAR) procedures has gained recognition for its effectiveness in achieving hernia repair and reducing the risk of further recurrence. However, limited research has been performed to explore the short-term outcomes and QoL assessment following these two surgical techniques. The aim of this study was to know the result after RS and TAR methods of hernia repair in terms of short-term recurrences, pain, postoperative complications, and QoL.

METHODS

This was a prospective, interventional study, which included 30 patients fulfilling the inclusion criteria. The study group was subjected to posterior component separation (PCS)-TAR and RS repair as per surgical indication (RS if defect size 4-10cm; PCS-TAR if defect size >10cm and </= 15cm). All post-operative patients were followed up at postoperative day (POD) seven, POD 30, and POD 90 for postoperative pain, complications, and QoL using the hernia-specific Carolina Comfort Scale (CCS). At the same time, recurrence was studied till POD 180.

RESULTS

Not a single recurrence was observed till POD 180 in either of the repair methods. The mean operative time for RS repair was 170.47 ± 15.08 minutes while for TAR repair was 188.8 ± 22.04 (p-value= 0.013). Surgical site infection (SSI) was reported in 14.28% of RS repair cases and 11.11% of TAR repair cases. Seroma formation was observed in 9.5% of RS repair cases. RS repair has less mean CCS score than TAR. The one-way ANOVA showed -ratio=421.43 and p-value=0.00001 for RS repair while -ratio= 298.05 and p-value=0 .00001 for TAR repair at POD seven, POD 30, and POD 90. Both RS and TAR repair markedly reduced mean scores in all three domains on POD 90.

CONCLUSION

Both RS and TAR had no recurrence in a short period of six months. The intraoperative time taken in TAR was less than in earlier studies. QoL improved postoperatively in both the repairs with RS repair having better QoL than TAR repair.

摘要

引言

腹疝是一种常见的外科病症,会对患者的生活质量(QoL)产生重大影响。采用里夫斯 - 斯托帕(RS)和腹横肌松解术(TAR)进行的开放性腹疝修补术,因其在实现疝修补及降低进一步复发风险方面的有效性而得到认可。然而,针对这两种手术技术后的短期疗效及生活质量评估的研究有限。本研究的目的是了解RS和TAR疝修补方法在短期复发、疼痛、术后并发症及生活质量方面的结果。

方法

这是一项前瞻性干预研究,纳入了30例符合纳入标准的患者。研究组根据手术指征接受后入路腹壁组织分离(PCS)-TAR和RS修补术(缺损大小4 - 10cm行RS修补;缺损大小>10cm且≤15cm行PCS-TAR修补)。所有术后患者在术后第7天、第30天和第90天进行随访,使用疝气专用的卡罗莱纳舒适度量表(CCS)评估术后疼痛、并发症及生活质量。同时,研究至术后第180天的复发情况。

结果

在术后第180天,两种修补方法均未观察到复发情况。RS修补术的平均手术时间为170.47±15.08分钟,而TAR修补术为188.8±22.04分钟(p值 = 0.013)。RS修补病例中有14.28%报告发生手术部位感染(SSI),TAR修补病例中有11.11%发生。RS修补病例中有9.5%观察到血清肿形成。RS修补的平均CCS评分低于TAR。在术后第7天、第30天和第90天,单因素方差分析显示RS修补的F值 = 421.43,p值 = 0.00001;TAR修补的F值 = 298.05,p值 = 0.00001。在术后第90天,RS和TAR修补在所有三个领域的平均评分均显著降低。

结论

RS和TAR在六个月的短时间内均无复发。TAR术中时间比早期研究中的短。两种修补术后生活质量均有所改善,RS修补的生活质量优于TAR修补。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e783/10411383/d4556863ca5f/cureus-0015-00000041637-i01.jpg

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