背景:采用后的早期,微创手术在急诊病例中的应用有限.然而,随着设备的改进,技术,和技能,腹腔镜在复杂和紧急手术中的应用大大扩展。这项研究旨在研究腹腔镜在嵌顿或绞窄腹壁疝修补术(VHR)中的趋势。
方法:美国外科医生学会国家外科质量改进计划(ACS-NSQIP)数据库被查询为腹腔镜修复嵌顿和绞窄疝(LIS-VHR),并在2个时间段进行了比较。2014-2016和2017-2019。
结果:腹腔镜检查在所有嵌顿或绞窄的VHR中的利用率随着时间的推移而增加(2014-2016年:39.9%(n=14075),而2017-2019年:46.3%(n=18369),P<.001)。虽然可能没有临床意义,人口统计学和合并症在组间有统计学差异(女性:51.7%vs50.0%,P=.003;年龄54.5±13.7vs55.4±13.8岁,P<.001;BMI34.9±8.0vs34.6±7.8kg/m2,P<.001)。2017年至2019年患者合并症较少(18.9%vs16.8%吸烟者,P<.001;18.2%vs17.3%糖尿病患者,P=.036;4.6%vs4.1%COPD,P=.021),但ASA分级较高(III:43.3%vs45.7%;IV:2.5%vs2.7%,P<.001)。疝类型(原发性,切开,复发性)在每组中相似。手术时间(89.7±59.3vs97.4±63.4分钟,P<.001)变得更长,但住院时间(1.4±3.3vs1.1±2.6天,P<.001)下降。手术并发症无统计学差异,医疗并发症,再操作,或期间之间的再入院率。
结论:腹腔镜VHR已成为治疗嵌顿和绞窄疝的常规方法,它的利用率随着时间的推移而不断增加。临床结果保持不变,而住院时间减少。
BACKGROUND: Early after its adoption, minimally invasive surgery had limited usefulness in emergent cases. However, with improvements in equipment, techniques, and skills, laparoscopy in complex and emergency operations expanded substantially. This study aimed to examine the trend of laparoscopy in incarcerated or strangulated ventral hernia repair (VHR) over time.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for laparoscopic repair of incarcerated and strangulated hernias (LIS-VHR) and compared over 2 time periods, 2014-2016 and 2017-2019.
RESULTS: The utilization of laparoscopy in all incarcerated or strangulated VHR increased over time (2014-2016: 39.9% (n = 14 075) vs 2017-2019: 46.3% (n = 18 369), P < .001). Though likely not clinically significant, demographics and comorbidities statistically differed between groups (female: 51.7% vs 50.0%, P = .003; age 54.5 ± 13.7 vs 55.4 ± 13.8 years, P < .001; BMI 34.9 ± 8.0 vs 34.6 ± 7.8 kg/m2, P < .001). Patients from 2017 to 2019 were less comorbid (18.9% vs 16.8% smokers, P < .001; 18.2% vs 17.3% diabetic, P = .036; 4.6% vs 4.1% COPD, P = .021) but had higher ASA classification (III: 43.3% vs 45.7%; IV: 2.5% vs 2.7%, P < .001). Hernia types (primary, incisional, recurrent) were similar in each group. Operative time (89.7 ± 59.3 vs 97.4 ± 63.4 min, P < .001) became longer but length-of-stay (1.4 ± 3.3 vs 1.1 ± 2.6 days, P < .001) decreased. There was no statistical difference in surgical complications, medical complications, reoperation, or readmission rates between periods.
CONCLUSIONS: Laparoscopic VHR has become a routine method for treating incarcerated and strangulated hernias, and its utilization continues to increase over time. Clinical outcomes have remained the same while hospital stays have decreased.