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首页> 外文期刊>Surgical Endoscopy >Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study.
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Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study.

机译：腹腔镜腹疝修补术中手术复杂性的临床预测因素：一项前瞻性研究。

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BACKGROUND: Because of uncertainties about the complexity of laparoscopic ventral hernia repair for varying patient populations, surgeons may be reluctant to perform this procedure. This study aimed to delineate the risk factors that can be identified in the preoperative setting predictive of longer operative times and complexity in laparoscopic ventral hernia repair. METHODS: Patient demographics including body mass index (BMI), comorbidities, previous laparoscopic and open surgical procedures, ventral hernia repairs, and hernia characteristics (defect size and location, adhesions, incarceration) were recorded prospectively. Data are given as mean +/- standard deviation. Times (min) required for abdominal access, adhesiolysis, and mesh placement as well as the total operative time were recorded during each case as outcome measures of operative difficulty. Univariate analyses were performed with the t-test or the Mann-Whitney U test as well as multivariate analyses using the stepwise analysis of covariance model to determine demographic and clinical variables influencing operative times. RESULT: The study enrolled 180 patients (78 men and 102 women) with a mean age of 54.8 +/- 12.2 years and a mean BMI of 33.3 +/- 13.0 kg/m(2). Multivariate analysis demonstrated significantly longer (p < 0.05) adhesiolysis and total operative times for patients with prior ventral hernia repairs, suprapubic hernia, bowel adhesion to the abdominal wall or hernia sac, and larger hernia defect. The total operative time also was increased (p < 0.05) with incarcerated hernia contents. Mesh placement time was increased (p < 0.05) with incarcerated hernia contents, suprapubic hernia location, hernias requiring larger mesh for repair, and decreased postgraduate year of the surgical assistant. The time required to obtain abdominal access was longer (p < 0.05) with a greater BMI and a higher American Society of Anesthesiology (ASA) classification. The operative times were not increased with a history of peritonitis, diabetes, immunosuppression, cancer, or with higher numbers of previous open or laparoscopic surgeries. CONCLUSIONS: At least 10 preoperatively identifiable patient variables, either alone or in combination, are predictive of prolonged operative times during laparoscopic ventral hernia repair and may be used as surrogates to determine the complexity of a minimally invasive approach.
机译：背景：由于不确定的腹腔镜腹疝修补术对于不同的患者人群的复杂性，外科医生可能不愿执行此过程。这项研究旨在勾勒出可以在术前设置中确定的危险因素，这些因素可预测腹腔镜腹侧疝修补术的手术时间更长和复杂性更高。方法：前瞻性地记录患者的人口统计资料，包括体重指数（BMI），合并症，以前的腹腔镜和开放手术，腹侧疝修补术和疝特征（缺陷大小和位置，粘连，嵌顿）。数据以平均值+/-标准偏差给出。在每种情况下，记录腹部进入，粘连溶解和网片放置所需的时间（分钟）以及总​​手术时间，作为手术难度的结局指标。使用t检验或Mann-Whitney U检验进行单变量分析，并使用协方差模型的逐步分析进行多元分析，以确定影响手术时间的人口统计学和临床​​变量。结果：该研究招募了180名患者（78名男性和102名女性），平均年龄为54.8 +/- 12.2岁，平均BMI为33.3 +/- 13.0 kg / m（2）。多变量分析显示，对于先前腹侧疝修补，耻骨上疝，肠粘连到腹壁或疝囊以及较大的疝缺损的患者，粘着溶解和总手术时间明显更长（p <0.05）。嵌顿疝气的内容也增加了总手术时间（p <0.05）。嵌顿疝气内容，耻骨上疝位置，需要较大网孔进行修补的疝气以及手术助手的研究生年减少，增加了网孔放置时间（p <0.05）。随着BMI的增加和美国麻醉学会（ASA）分类的提高，获得腹部入路所需的时间更长（p <0.05）。有腹膜炎，糖尿病，免疫抑制，癌症史或以前的开放式或腹腔镜手术次数较多，手术时间没有增加。结论：至少有10个术前可识别的患者变量，无论是单独还是结合使用，都可预测腹腔镜腹疝修补术中手术时间的延长，并可作为确定微创方法的复杂性的替代方法。

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