Becker Timothy P, Duggan Ben, Rao Varun, Deleon Genaro, Pei Kevin
General Surgery, Indiana University School of Medicine, Indianapolis, USA.
Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA.
Cureus. 2023 Sep 21;15(9):e45699. doi: 10.7759/cureus.45699. eCollection 2023 Sep.
Introduction It has been suggested that hernia repair with concomitant cholecystectomy increases the risk of postoperative complications due to potential mesh contamination. This study compares postoperative outcomes and complications between patients who underwent ventral hernia repair (VHR) with and without concomitant cholecystectomy (CCY). Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, from 2005 to 2019, we queried patients who underwent ventral hernia repairs using the current procedural terminology (CPT) codes 49652-49657 (laparoscopic) and 49560-49566 (open), with or without cholecystectomy. The ACS NSQIP is a prospective, systematic study of patients who underwent major general surgical procedures aggregating data from over 200 hospitals. Cases involving additional concomitant procedures were excluded. Primary outcomes of interest were 30-day mortality, length of stay, readmission, return to operating room (OR), and postoperative complications. The odds ratio for primary outcomes was calculated using multivariable binomial logistic regression to control for patient risk factors. Results In total, 167586 cases were identified, 165,758 ventral hernia repairs alone, and 1,828 ventral hernia repairs with concomitant cholecystectomy. There was no difference in 30-day mortality, length of stay, readmission, return to the operating room, or postoperative complications between groups. Patients who underwent simultaneous VHR/CCY when compared to those who had VHR alone, had no differences in the rate of surgical site infections (1.86% vs. 1.97%, P = 0.57) or sepsis (0.82% vs. 0.41%, P = 0.10). Conclusion In a large national sample, there is no significant difference in postoperative outcomes, specifically infection-related complications, when comparing VHR along with concurrent VHR/CCY. Our findings suggest no increased risks for patients undergoing concurrent ventral hernia repair and cholecystectomy. Hence, surgeons might consider this combined approach to offer the best value-based care, especially when it could eliminate the need for a second operation and the risk of infection is low. Prospective studies with more procedural-specific information for hernia repairs and indications for cholecystectomy are needed however it is likely safe to perform both procedures during the same setting in cholecystectomy cases lacking signs of acute infection.
引言 有人认为，疝修补术同时行胆囊切除术会因潜在的补片污染而增加术后并发症的风险。本研究比较了接受腹疝修补术（VHR）且伴有或不伴有胆囊切除术（CCY）的患者的术后结局和并发症。方法 利用美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库，在2005年至2019年期间，我们查询了使用当前手术操作术语（CPT）编码49652 - 49657（腹腔镜）和49560 - 49566（开放）进行腹疝修补术的患者，无论是否进行胆囊切除术。ACS NSQIP是一项对接受大型普通外科手术患者的前瞻性、系统性研究，汇总了来自200多家医院的数据。排除涉及额外同期手术的病例。感兴趣的主要结局是30天死亡率、住院时间、再入院、返回手术室（OR）以及术后并发症。使用多变量二项逻辑回归计算主要结局的比值比，以控制患者风险因素。结果 总共识别出167586例病例，其中单纯腹疝修补术165758例，腹疝修补术同时行胆囊切除术1828例。两组之间在30天死亡率、住院时间、再入院、返回手术室或术后并发症方面没有差异。与单纯行VHR的患者相比，同时行VHR/CCY的患者在手术部位感染率（1.86%对1.97%，P = 0.57）或脓毒症发生率（0.82%对0.41%，P = 0.10）上没有差异。结论 在一个大型全国样本中，比较VHR以及同期VHR/CCY时，术后结局，特别是与感染相关的并发症，没有显著差异。我们的研究结果表明，同时进行腹疝修补术和胆囊切除术的患者风险没有增加。因此，外科医生可能会考虑这种联合方法以提供基于最佳价值的治疗，特别是当它可以避免二次手术且感染风险较低时。然而，需要进行更具手术特异性信息的疝修补术和胆囊切除术指征的前瞻性研究，不过在缺乏急性感染迹象的胆囊切除病例中，在同一手术环境下同时进行这两种手术可能是安全的。
