目的:比较开放的临床结果,腹腔镜,和直接的机器人疝气修复,单侧腹股沟疝修补术,特别关注30天发病率手术部位感染(SSI);手术部位发生(SSO);需要手术干预的SSI/SSO(SSOPI),再操作,和复发。
方法:在腹部核心健康质量协同数据库中查询了接受择期治疗的患者,小学,内侧>3厘米,单侧腹股沟疝修补术(Lichtenstein),腹腔镜,或机器人手术方法。术前人口统计学和患者特征,手术技术,并对结果进行了研究。对每个手术方法对使用1对1的倾向得分匹配算法,以减少选择偏差。
结果:包括848例手术:297例开放,285腹腔镜,和266个机器人疝气修复。没有证据表明30天的主要终点有差异,包括SSI,SSO,需要程序干预的SSI/SSO(SSOPI),再操作,重新接纳,或任何手术入路对的复发(开放与机器人,开放式vs.腹腔镜,机器人vs.腹腔镜)。对于开放与腹腔镜组,与开腹手术相比,腹腔镜手术30天的QoL评分更低(更好)(OR0.53[0.31,0.92],p=0.03),但这一差异在为期1年的调查中不成立(OR1.37[0.48,3.92],p=0.55)。同样,接受机器人修复的患者更有可能有更高(更差)的30天QoL评分(OR2.01[1.18,3.42],p=0.01),但没有证据表明1年有差异(OR0.83[0.3,2.26]p=0.71)。
结论:我们的研究没有揭示开放手术后的显著结果,腹腔镜,和大型内侧腹股沟疝的机器人入路。外科医生应继续根据患者需求和自己的外科专业知识定制手术方法。
To compare clinical outcomes for open, laparoscopic, and robotic hernia repairs for direct, unilateral inguinal hernia repairs, with particular focus on 30-day morbidity surgical site infection (SSI); surgical site occurrence (SSO); SSI/SSO requiring procedural interventions (SSOPI), reoperation, and recurrence.
The Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective, primary, > 3 cm medial, unilateral inguinal hernia repairs with an open (Lichtenstein), laparoscopic, or robotic operative approach. Preoperative demographics and patient characteristics, operative techniques, and outcomes were studied. A 1-to-1 propensity score matching algorithm was used for each operative approach pair to reduce selection bias.
There were 848 operations included: 297 were open, 285 laparoscopic, and 266 robotic hernia repairs. There was no evidence of a difference in primary endpoints at 30 days including SSI, SSO, SSI/SSO requiring procedural interventions (SSOPI), reoperation, readmission, or recurrence for any of the operative approach pairs (open vs. robotic, open vs. laparoscopic, robotic vs. laparoscopic). For the open vs. laparoscopic groups, QoL score at 30 day was lower (better) for laparoscopic surgery compared to open surgery (OR 0.53 [0.31, 0.92], p = 0.03), but this difference did not hold at the 1-year survey (OR 1.37 [0.48, 3.92], p = 0.55). Similarly, patients who underwent robotic repair were more likely to have a higher (worse) 30-day QoL score (OR 2.01 [1.18, 3.42], p = 0.01), but no evidence of a difference at 1 year (OR 0.83 [0.3, 2.26] p = 0.71).
Our study did not reveal significant post-operative outcomes between open, laparoscopic, and robotic approaches for large medial inguinal hernias. Surgeons should continue to tailor operative approach based on patient needs and their own surgical expertise.