Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients
Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients
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DOI：
10.1007/s10029-007-0310-8
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发表时间：
2008-06-01
期刊：
影响因子：
2.3
通讯作者：
Ramshaw, B. J.
中科院分区：
文献类型：
--
作者：
Tsereteli, Z.;Pryor, B. A.;Ramshaw, B. J.
目的本研究的目的是评估我们在病态肥胖患者（BMI> 40）LVHR方面的经验，并将其结果与BMI较低的患者进行比较。方法回顾性收集了过去13年中由4名经验丰富的外科医生进行LVHR补片的成人（> 18岁）患者的数据，并从先前收集的数据库中收集。在1，071名患者中，901名完成了LVHR并可进行随访。134例患者（A组）符合病态肥胖的BMI标准（40，平均46），767例患者BMI <40，平均30（B组）。随访时间1~91个月。使用Wilcoxon秩和检验进行非参数数据分析。结果分层随访时间和分析使用Cochran-Mantel-Haenszel methodology.Results组没有不同的ASA评分，以前的手术和转换率（p = 0.22，0.32和0.23）。病态肥胖患者更年轻（48.3 vs. 54; p <0.01），女性更常见（p = 0.02），但这与预后无关。A组的手术时间（154 vs. 119 min，p <0.01）和住院时间（3.6 vs. 2.4 d，p = 0.03）也更长。A组的补片尺寸明显更大（449 cm vs. 349 cm（2），p = 0.02）。在19个月的平均随访时间内，A组和B组的疝复发率分别为8.3%和2.9%（p = 0.003），比值比为4.3（95% CI 1.9 - 9.9）。然而，并发症的发生率没有显着差异（19.7 vs. 15.3%; p = 0.46）。结论LVHR在病态肥胖人群中是安全可行的，虽然有较高的，但仍然可以接受的复发率。尽管复发风险增加，但病态肥胖患者的LVHR最大限度地减少了该组患者开放式补片修复术经常发生的潜在伤口和补片并发症。
Objective The aim of this study was to evaluate our experience with LVHR in morbidly obese patients (BMI > 40) and to compare their outcomes to those of patients with lower BMI.Methods Data on adult (> 18 years old) patients who underwent LVHR with mesh over the last 13 years performed by four experienced surgeons were collected retrospectively and from a previously collected database. Of the 1,071 patients, 901 had completed LVHR and were available for follow-up. One hundred and thirty-four patients (group A) met BMI criteria for morbid obesity (, 40, mean 46), 767 patients had BMI < 40, mean 30 (group B). The follow-up time ranged from 1 to 91 months. The Wilcoxon rank sum test was used for nonparametric data analysis. Outcomes were stratified on the follow up time and analyzed using Cochran-Mantel-Haenszel methodology.Results The groups did not differ in terms of ASA score, previous surgery and conversion rate (p = 0.22, 0.32 and 0.23). Morbidly obese patients were younger (48.3 vs. 54; p < 0.01) and were more often female (p = 0.02), but this did not correlate with outcome. Group A also had longer operative time (154 vs. 119 min, p < 0.01) and hospital stay (3.6 vs. 2.4 days, p = 0.03). Mesh size was significantly larger in group A (449 vs. 349 cm(2), p = 002). During mean follow-up time of 19 months hernia recurrence was 8.3% in group A and 2.9% in group B (p = 0.003), with an odds ratio of 4.3 (95% CI 1.9-9.9). However, there was no significantly difference in the rate of complications (19.7 vs. 15.3%; p = 0.46).Conclusions LVHR in the morbidly obese population is both safe and feasible, although there is a higher, but still acceptable recurrence rate. Despite the increased risk for recurrence, LVHR in morbidly obese patients minimizes the potential wound and mesh complications that frequently occur for open mesh repair in this group of patients.