Ellis Ryan, Maskal Sara, Prabhu Ajita, Petro Clayton, Beffa Lucas, Rosen Michael, Miller Benjamin, Krpata David
Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Surg Endosc. 2023 Nov;37(11):8799-8803. doi: 10.1007/s00464-023-10350-0. Epub 2023 Aug 17.
Core abdominal injury (CAI) is a broad term that describes injuries resulting from repetitive loading of the pubis that leads to inflammation, rupture, or destabilization of the core muscles from the pubic bone. There is no clear recommendation on the surgical approach to CAI. We aimed to describe how hernia surgeons within the Abdominal Core Health Quality Collaborative (ACHQC) address this problem surgically and the short-term outcomes.
We queried the ACHQC registry for patients undergoing surgery for isolated CAI and concomitant inguinal hernias (IH) and CAI. Operative approach and quality of life (using EuraHS survey scores) was abstracted.
A total of 29,451 patients underwent surgery for IHs, CAIs, or both within the registry. Twenty patients underwent surgery for isolated CAI (median age 29, 90% males). Eleven patients (55%) underwent surgery with mesh (four Lichtenstein, three TAPP, and four TEP). Nine patients (45%) underwent tissue-based repairs (four closure of floor, one Bassini, one McVay, one Shouldice, one femoral exploration, and one laparoscopic-to-open conversion). There were no postoperative complications or reoperations within 30 days. EuraHS scores showed improvement at 30 days from baseline (median 29 [6.75-41.75] from 42 [29.42-57.61]). Sixty patients had both IHs and CAIs (median age 31, 97% males). All patients received mesh. Thirty-one patients (52%) underwent open surgery (23 Lichtenstein, 1 plug, 7 TREPP) and 29 underwent minimally invasive repairs (23 TAPP, 6 TEP). There was one seroma at 30 days. EuraHS scores showed improvement at 30 days from baseline (median 16 [5.17-27.33] from 37.5 [26.44-46.58]).
Despite technical variability, CAIs with or without concomitant IH generally undergo operations commonly used for IH repairs. Within our series, there was inconsistency with approach and mesh placement. Future work should be focused on standardizing the approach to CAI and capturing long-term data within the ACHQC.
核心腹部损伤（CAI）是一个广义术语，用于描述耻骨反复受力导致核心肌肉从耻骨发生炎症、破裂或失稳所引起的损伤。目前对于CAI的手术治疗方法尚无明确建议。我们旨在描述腹部核心健康质量协作组（ACHQC）中的疝外科医生如何通过手术解决这一问题以及短期疗效。
我们查询了ACHQC登记处中接受孤立性CAI手术以及合并腹股沟疝（IH）和CAI手术的患者信息。提取了手术方式和生活质量（使用EuraHS调查评分）的数据。
登记处共有29451例患者接受了IH、CAI或两者的手术。20例患者接受了孤立性CAI手术（中位年龄29岁，90%为男性）。11例患者（55%）接受了补片修补手术（4例Lichtenstein手术、3例经腹膜前修补术（TAPP）和4例全腹膜外修补术（TEP））。9例患者（45%）接受了基于组织的修补手术（4例盆底闭合术、1例Bassini手术、1例McVay手术、1例Shouldice手术、1例股部探查术和1例腹腔镜中转开放手术）。30天内无术后并发症或再次手术情况。EuraHS评分显示，与基线相比，30天时有所改善（中位数从42[29.42 - 57.61]降至29[6.75 - 41.75]）。60例患者同时患有IH和CAI（中位年龄31岁，97%为男性）。所有患者均接受了补片修补。31例患者（52%）接受了开放手术（23例Lichtenstein手术、1例塞子修补术、7例经腹膜前修补术（TREPP）），29例接受了微创手术（23例TAPP、6例TEP）。30天时出现1例血清肿。EuraHS评分显示，与基线相比，30天时有所改善（中位数从37.5[26.44 - 46.58]降至16[5.17 - 27.33]）。
尽管技术存在差异，但无论是否合并IH，CAI通常都采用常用于IH修补的手术方法。在我们的系列研究中，手术方式和补片放置存在不一致性。未来的工作应集中于规范CAI的手术方法，并在ACHQC中收集长期数据。
