Oregon Health & Science University, Department of Surgery, Portland, OR. Electronic address: https://twitter.com/salgado_garza.
Oregon Health & Science University, Department of Surgery, Portland, OR.
Surgery. 2024 Sep;176(3):769-774. doi: 10.1016/j.surg.2024.04.036. Epub 2024 Jun 10.
Umbilical hernias are highly prevalent in patients with liver dysfunction, ascites, and cirrhosis. This patient population carries significant perioperative risk and poses significant challenges because of their comorbidities. Literature suggests that elective repair of umbilical hernias can lead to better outcomes by reducing the risk of ascitic leak and compromised bowel. Medical optimization followed by open repair has been the standard approach; however, little is known about whether a laparoscopic approach may be equivalent or superior.
We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2021 for umbilical hernia repairs in patients with liver dysfunction, as defined per the aspartate aminotransferase to platelet ratio index ≥1. We compare operative outcomes for open and laparoscopic repair, adjusting for confounders using propensity score matching and stratifying by case acuity.
We identified 1,983 patients with liver dysfunction who underwent umbilical hernia repair. Most patients (86%) were operated via an open approach rather than laparoscopy. Operative outcomes between the laparoscopy and open group were comparable regarding mortality and serious complications. Notably, length of stay and need for blood transfusion intraoperatively or postoperatively were reduced in the laparoscopy group (P < .001). These findings remained significant after subgroup analysis with propensity matching stratified by elective and emergency case types.
Minimally invasive umbilical hernia repair in liver dysfunction is as safe and, in some metrics, superior to open technique. We found no difference in mortality although hospital stays and the need for blood transfusions were lower in the laparoscopy groups. Prospective randomized trials are needed to validate these findings further.
脐疝在肝功能障碍、腹水和肝硬化患者中非常普遍。这类患者群体具有显著的围手术期风险，并因合并症而带来巨大挑战。文献表明，选择性修复脐疝可以通过降低腹水漏和肠道受损的风险，从而获得更好的结果。对患者进行医学优化后再行开放修复一直是标准方法；然而，对于腹腔镜方法是否同样有效或更优，我们知之甚少。
我们回顾性分析了 2015 年至 2021 年美国外科医师学会国家外科质量改进计划数据库中肝功能障碍患者（根据天门冬氨酸氨基转移酶与血小板比值指数≥1 定义）的脐疝修复数据。我们通过倾向评分匹配和按病例严重程度分层来调整混杂因素，比较开放和腹腔镜修复的手术结果。
我们确定了 1983 例肝功能障碍患者接受了脐疝修复。大多数患者（86%）通过开放手术而不是腹腔镜手术进行治疗。在死亡率和严重并发症方面，腹腔镜组和开放组之间的手术结果相当。值得注意的是，腹腔镜组的住院时间和术中或术后输血需求减少（P<0.001）。在按择期和急诊病例类型进行倾向匹配分层的亚组分析中，这些发现仍然具有统计学意义。
在肝功能障碍患者中，微创脐疝修复与开放技术一样安全，在某些指标上甚至更优。尽管腹腔镜组的死亡率没有差异，但住院时间和输血需求较低。需要进一步进行前瞻性随机试验来验证这些发现。
