METHODS: Patients who have undergone VHR + DR with a minimum 30-day follow-up complete were identified. Outcomes of interest included operative details, surgical site occurrences (SSO), medical complications, and readmissions.
RESULTS: 169 patients (51% female, median age 46, median body mass index 31 kg/m2) were identified. Most hernias were primary (64% umbilical, 28% epigastric). Median hernia width was 3 cm (IQR 2-4) and median diastasis width and length were 4 cm (IQR 3-6) and 15 cm (IQR 10-20), respectively. Most operations were robotic (79%), with a synthetic mesh (92%) placed as a sublay (72%; 59% retromuscular, 13% preperitoneal). DR was repaired with absorbable (92%) and running suture (93%). Considering our cohort\'s relatively small diastasis and hernia size, a high rate of transversus abdominis release was noted (14.7%). 76% were discharged the same day and the 30-day readmission rate was 2% (2 ileus, 1 pneumonia). SSO rate was 4% (6 seromas, 1 skin necrosis) and only one patient required a procedural intervention.
CONCLUSIONS: ACHQC participating surgeons usually perform VHR + DR robotically with a retromuscular synthetic mesh and close the DR with running absorbable sutures. Short-term complications occurred in approximately 6% of patients and were mainly managed without interventions. Larger studies with longer-term follow-up are needed to determine the value of VHR + DR.
方法:确定接受VHR+DR并至少完成30天随访的患者。感兴趣的结果包括手术细节,手术部位发生(SSO),医疗并发症,和再入院。
结果:169名患者(51%为女性,中位年龄46,中位体重指数31kg/m2)。大多数疝是原发性的(64%的脐疝,28%的上腹部)。中位疝宽度为3cm(IQR2-4),中位疝宽度和长度为4cm(IQR3-6)和15cm(IQR10-20),分别。大多数操作都是机器人(79%),与合成网(92%)放置为基础(72%;59%的肌肉后,13%腹膜前)。DR用可吸收(92%)和连续缝合(93%)修复。考虑到我们的队列相对较小的扩张和疝大小,腹横肌释放率很高(14.7%).76%当天出院,30天再入院率为2%(2次肠梗阻,1肺炎)。SSO率为4%(6例血清,1个皮肤坏死),只有一名患者需要手术干预。
结论:ACHQC参与手术的外科医生通常使用肌后合成网机器人进行VHR+DR,并使用可吸收缝线闭合DR。短期并发症发生在大约6%的患者中,主要在没有干预的情况下进行管理。需要更大规模的研究和更长期的随访来确定VHR+DR的价值。