Bianchi Juliana Melo, Arias-Espinosa Luis, Freyria Ana, Chauhan Anupam Singh, Xie Weipeng, Ma Jianing, Huang Li-Ching, Pereira Xavier, Bussert Timothy, Malcher Flavio
Department of Obstetrics and Gynecology, SUNY Upstate Medical University, Syracuse, NY, USA.
Division of General Surgery, New York University Langone Health, New York, NY, 10016, USA.
Hernia. 2025 Apr 8;29(1):137. doi: 10.1007/s10029-025-03326-7.
The aim of this paper is to compare outcomes of patients who underwent combined gynecologic procedures with ventral hernia repair (VHR) with patients that underwent only VHR.
Patients who underwent VHR with a combined gynecological procedure from 2012 to 2023 were retrospectively identified in the Abdominal Core Health Quality Collaborative and categorized into two groups with surgical wound contamination in mind. Group one included patients with concomitant salpingo-oophorectomy (SO), bilateral tubal ligation (BTO), and/or ovarian cystectomy (OC) without hysterectomy. Group two consisted of patients who underwent hysterectomy with or without SO/BTO/OC/ER. C-Sections were excluded. Mesh location was 90% in the sublay space for both groups. Patients who underwent VHR without any concomitant procedure were the control group. Propensity score matching (PSM; ratio 3:1 for control vs. group one and 1:1 for control vs. group two) was performed based on relevant demographic and perioperative covariates (age, hernia width, operative approach, ASA class, BMI, mesh used, current smoker, wound status, year of operation, and recurrent). Postoperative outcomes at 30 days were compared between group one and control and between group two and control based on post-PSM cohorts.
Out of 13,982 patients undergoing VHR, 279 (2%) also underwent a concurrent gynecological procedure. Following PSM, 88 patients in Group 1 were matched with 264 patients that underwent VHR alone. Similarly, 186 patients in Group 2 were compared with 186 patients in the control group. Operative time was significantly higher in both groups as compared to control (p < 0.001). A longer LOS and more EBL were observed group 2 but not group 1. No statistically significant differences were observed in either group regarding surgical site infection (SSI), surgical site occurrence (SSO), Surgical site occurrences requiring procedural interventions (SSOPI), recurrence of hernia, reoperations, or readmissions.
This study compares the outcomes of patients that underwent VHR with simultaneous gynecological procedure to patients with VHR alone. Combining hernia repair and gynecologic surgery did not appear to have an adverse impact on clinical outcomes. Our study suggests that further collaboration between gynecology and general surgery can be considered for management of concurrent abdominopelvic pathologies.
本文旨在比较接受妇科联合手术与腹疝修补术（VHR）的患者与仅接受VHR的患者的治疗结果。
在腹部核心健康质量协作组中回顾性识别2012年至2023年期间接受VHR联合妇科手术的患者，并根据手术伤口污染情况将其分为两组。第一组包括同时进行输卵管卵巢切除术（SO）、双侧输卵管结扎术（BTO）和/或卵巢囊肿切除术（OC）但未行子宫切除术的患者。第二组由接受子宫切除术并伴有或不伴有SO/BTO/OC/ER的患者组成。剖宫产被排除在外。两组患者90%的补片放置于腹膜前间隙。未进行任何联合手术而仅接受VHR的患者作为对照组。根据相关人口统计学和围手术期协变量（年龄、疝宽度、手术入路、美国麻醉医师协会分级、体重指数、使用的补片、当前吸烟者、伤口状况、手术年份和复发情况）进行倾向评分匹配（PSM；对照组与第一组的比例为3:1，对照组与第二组的比例为1:1）。根据PSM后的队列，比较第一组与对照组以及第二组与对照组之间术后30天的结果。
在13982例接受VHR的患者中，279例（2%）同时进行了妇科手术。PSM后，第一组的88例患者与264例仅接受VHR的患者进行匹配。同样，第二组的186例患者与对照组的186例患者进行比较。与对照组相比，两组的手术时间均显著延长（p < 0.001）。第二组观察到住院时间更长和术中出血量更多，但第一组未观察到。在手术部位感染（SSI）、手术部位事件（SSO）、需要手术干预的手术部位事件（SSOPI）、疝复发、再次手术或再次入院方面，两组均未观察到统计学上的显著差异。
本研究比较了接受VHR同时进行妇科手术的患者与仅接受VHR的患者的治疗结果。疝修补术与妇科手术联合似乎对临床结果没有不利影响。我们的研究表明，对于同时存在的盆腔疾病的管理，可以考虑妇科与普通外科之间进一步合作。
