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首页> 外文期刊>Surgical endoscopy >Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a National Surgical Quality Improvement Program review
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Updated outcomes of laparoscopic versus open umbilical hernia repair in patients with obesity based on a National Surgical Quality Improvement Program review

机译：腹腔镜与开放性脐疝修复术在肥胖患者中的更新结果，基于国家外科质量改进计划审查

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Background Currently, there's not a well-accepted optimal approach for umbilical hernia repair in patients with obesity when comparing laparoscopic umbilical hernia repair (LUHR) versus open umbilical hernia repair (OUHR). Objective The objective of this study was to evaluate if there's a difference in postoperative complications after LUHR versus OUHR with the goal of indicating an optimal approach. Methods A retrospective analysis was completed using the 2016 National Surgical Quality Improvement Program (NSQIP) database to identify patients with obesity (Body Mass Index (BMI) >= 30 kg/m(2)) who underwent LUHR or OUHR. Patients were divided into OUHR and LUHR groups, and post-operative outcomes were compared, focusing on wound complications. Results A total of 12,026 patients with obesity who underwent umbilical hernia repair were identified; 9695 underwent OUHR, while 2331 underwent LUHR. The LUHR group was found to have a statistically significant higher BMI (37.5 kg/m(2) vs. 36.1 kg/m(2); p < 0.01) and higher incidence of diabetes mellitus requiring therapy (18.4 vs. 15.8; p < 0.01), hypertension (47.5 vs. 43.8; p < 0.01), and current smoker status (18.6 vs. 16.5; p < 0.02). Superficial surgical site infection (SSI) was significantly higher in the OUHR group (1.5 vs. 0.9; p < 0.03), and there was a trend towards higher deep SSI in the OUHR group (0.3 vs. 0.5; p = 0.147). There was no difference in organ space SSI, wound disruption, or return to OR. On logistic regression, composite SSI rate (defined as superficial, deep, and organ space SSIs) was significantly increased in the OUHR group (p < 0.01). Predictive factors significantly associated with increased morbidity included female gender and higher BMI. Conclusions In patients with obesity, even though the LUHR group had an overall higher BMI and higher rates of diabetes, hypertension, and current smoking status, they experienced decreased post-operative wound complications compared to the OUHR group.
机译：背景 目前，在比较腹腔镜脐疝修补术 （LUHR） 与开放性脐疝修补术 （OUHR） 时，尚无公认的肥胖患者脐疝修补术的最佳方法。目的 本研究的目的是评估 LUHR 与 OUHR 术后并发症是否存在差异，目的是指出最佳方法。方法 利用2016年美国国家外科质量改进计划（NSQIP）数据库进行回顾性分析，确定接受LUHR或OUHR的肥胖患者（体重指数（BMI）>=30 kg/m（2））。将患者分为 OUHR 组和 LUHR 组，比较术后结局，重点关注伤口并发症。结果 共纳入12 026例接受脐疝修补术的肥胖患者;9695 人接受了 OUHR，而 2331 人接受了 LUHR。LUHR组的BMI较高（37.5 kg/m（2）vs. 36.1 kg/m（2）;p < 0.01），需要治疗的糖尿病发生率更高（18.4% vs. 15.8%;p < 0.01）、高血压（47.5% vs. 43.8%;p < 0.01）和当前吸烟者状况（18.6% vs. 16.5%;p < 0.02）。OUHR组的浅表手术部位感染（SSI）显著升高（1.5% vs. 0.9%;p < 0.03），而OUHR组的深部SSI有升高的趋势（0.3% vs. 0.5%;p = 0.147）。器官间隙SSI、伤口破坏或返回手术室没有差异。在logistic回归上，OUHR组的复合SSI率（定义为浅表、深部和器官间隙SSI）显著增加（p < 0.01）。与发病率增加显著相关的预测因素包括女性和较高的BMI。结论 在肥胖患者中，尽管LUHR组总体BMI较高，糖尿病、高血压和当前吸烟状况的发生率较高，但与OUHR组相比，他们的术后伤口并发症有所减少。

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