Preoperative computed tomography for acutely incarcerated ventral or inguinal hernia.
Preoperative computed tomography for acutely incarcerated ventral or inguinal hernia.
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DOI：
10.1016/j.surg.2022.01.014
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发表时间：
2022-07
期刊：
影响因子：
3.8
通讯作者：
Loftus, Tyler J.
中科院分区：
文献类型：
--
作者：
Knewitz, Daniel K.;Kirkpatrick, Stacey L.;Jenkins, Phillip D.;Al-Mansour, Mazen;Rosenthal, Martin D.;Efron, Philip A.;Loftus, Tyler J.
术前计算机断层扫描（CT）用于紧急腹壁疝修补术的实用性尚不清楚。本研究检验了一个假设，即术前CT诊断的急性嵌顿性腹疝或腹股沟疝与单纯临床评估的患者结局没有差异。该回顾性队列分析包括270例接受腹疝或腹股沟疝紧急修补术的成人患者。比较术前CT检查患者（N=179）与术前未CT检查患者（N=91）的人口统计学资料、并发症风险因素、手术管理策略和1年结局。在179例术前CT扫描中，15例（8.4%）由外科医生订购，所有其他均由转诊提供者订购。CT组和非CT组的年龄相似（58 vs. 58岁，P=.77），体重指数（30.7与30.6 kg/m2，P= 0.30），美国麻醉医师学会分级（3.0 vs. 3.0，P= 0.39），全身炎症反应综合征的发生率（19.0% vs. 20.9%，P= 0.75）和复发疝发生率（16.8% vs. 19.8%，P= 0.61）。CT组患者入院至切开的时间较长（11.2小时对6.6小时，P<0.001）。CT组和无CT组的手术持续时间相似（两组均为125分钟，P=.88），使用生物补片的患者比例（21.2% vs. 17.6%，P= 0.52）和合成补片（35.2% vs. 46.2%，P= 0.09）放置和1年结局，包括浅表（8.4% vs. 6.6%，P= 0.81）和深部或器官/间隙手术部位感染（5.0% vs. 6.6%，P= 0.59），因感染取出补片（2.2% vs. 3.3%，P= 0.69）、复发疝再次手术（3.9% vs. 1.1%，P= 0.27）和死亡率（7.8% vs. 4.4%，P= 0.44）。术前CT的性能与入院和切口之间的时间间隔较长相关，补片放置、补片类型或1年患者结局无差异。这些结果支持仅根据临床评估进行急性嵌顿性腹疝或腹股沟疝紧急修补术的安全性。
The utility of preoperative computed tomography (CT) for urgent abdominal wall hernia repair is unclear. This study tests the hypothesis that there is no difference in patient outcomes for acutely incarcerated ventral or inguinal hernias diagnosed by preoperative CT versus clinical assessment alone. This retrospective cohort analysis included 270 adult patients undergoing urgent repair of ventral or inguinal hernia. Demographics, risk factors for complications, operative management strategies, and 1-year outcomes were compared between patients with (N=179) versus without (N=91) preoperative CT. Among 179 preoperative CT scans, 15 (8.4%) were ordered by surgeons and all others were ordered by referring providers. The CT and no CT groups had similar age (58 vs. 58 years, P=.77), body mass index (30.7 vs. 30.6 kg/m2, P=.30), American Society of Anesthesiologists class (3.0 vs. 3.0, P=.39), incidence of the systemic inflammatory response syndrome (19.0% vs. 20.9%, P=.75), and incidence of recurrent hernia (16.8% vs. 19.8%, P=.61). The interval between admission and incision was longer in the CT group (11.2 hours vs. 6.6 hours, P<.001). The CT and no CT groups had similar duration of surgery (125 minutes in both groups, P=.88), proportions of patients with biologic mesh (21.2% vs. 17.6%, P=.52) and synthetic mesh (35.2% vs. 46.2%, P=.09) placement, and 1-year outcomes including incidence of superficial (8.4% vs. 6.6%, P=.81) and deep or organ/space surgical site infection (5.0% vs. 6.6%, P=.59), mesh explant for infection (2.2% vs 3.3%, P=.69), reoperation for recurrent hernia (3.9% vs. 1.1%, P=.27), and mortality (7.8% vs. 4.4%, P=.44). The performance of preoperative CT was associated with a longer interval between admission and incision and no differences in mesh placement, mesh type, or 1-year patient outcomes. These results support the safety of performing urgent repair of acutely incarcerated ventral or inguinal hernias based on clinical assessment alone.
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DOI：
10.1007/s00464-019-07245-4
发表时间：
2020-10
期刊：
Surgical endoscopy
影响因子：
--
作者：
Leeds IL;Jones C;DiBrito SR;Sakran JV;Haut ER;Kent AJ
通讯作者：
Kent AJ
影响因子：
5.4
作者：
Levinson, Wendy;Kallewaard, Marjon;Kerr, Eve A.
通讯作者：
Kerr, Eve A.
影响因子：
5
作者：
Parker, Laurence;Nazarian, Levon N.;Frangos, Andrea J.
通讯作者：
Frangos, Andrea J.
影响因子：
2.3
作者：
Yang, L.;Wang, H.;Wang, J.
通讯作者：
Wang, J.
影响因子：
1.9
作者：
Chen, SC;Lee, CC;Chen, WJ
通讯作者：
Chen, WJ