胰腺大部切除术后的切口疝：来自两个不同来源的长期风险评估--一个大型多机构网络和一个单一高容量中心

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-12-01 DOI:10.1016/j.hpb.2024.08.009

Nitzan Zohar, Eliyahu Gorgov, Theresa P. Yeo, Harish Lavu, Wilbur Bowne, Charles J. Yeo, Avinoam Nevler

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引用次数: 0

摘要

术后切口疝（IH）是腹部手术后常见的并发症。有关胰腺大手术后切口疝的数据非常有限。我们旨在评估大胰腺切除术后 IH 的长期风险。我们开展了一项双途径研究：在一个大型多机构研究网络（RN）中调查了胰十二指肠切除术（PD）和远端胰切除术（DP）后倾向分数匹配的幸存者的 IH 发生率和风险因素，并对胰腺手术幸存者群组进行了患者报告问卷调查，以评估 IH 发生率。RN分析确定了22113名接受过胰腺手术的患者，并创建了7092对匹配的胰腺切除术和胰腺切除术患者（随访时间大于1年）。11.0%的胰腺癌患者和8.6%的直肠癌患者发生了IH（P 35与胰腺癌和直肠癌的IH发生率增加相关（OR=1.87和OR=1.86，P均<0.0001）），术后腹腔内感染和吻合口漏也与IH发生率增加相关（OR=1.53和OR=1.59，P均<0.0001）。对 104 名患者进行的患者调查显示，16 名患者（15%）在随访期间报告了术后 IH。BMI≥30、SSI和腹腔内脓肿与IH风险增加有关（P＜0.05）。胰腺切除术后生存率的提高导致长期手术后遗症的发生率增加。在这项研究中，我们证明了长期幸存者中 IH 的显著发生率，并评估了潜在的风险因素。

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Incisional hernia after major pancreatic resection: long term risk assessment from two distinct sources – A large multi-institutional network and a single high-volume center

Background

Post-operative incisional hernia (IH) is a common complication following abdominal surgery. Data regarding IH after major pancreatic surgery are limited. We aim to evaluate the long-term risk of IH following major pancreatic resection.

Methods

A dual-approach study: a large multi-institutional research network (RN) was investigated for IH incidence and risk factors in propensity-score matched survivors after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), was complemented by a patient-reported questionnaire.

Results

RN analysis identified 22,113 patients that underwent pancreatic surgery. 11.0% of PD patients and 8.6% of DP patients developed IH (P < 0.0001). IH rates were higher with open surgery compared with minimally invasive approaches in PD (OR = 1.56, P = 0.03) and DP (OR = 1.94, P = 0.003). BMI>35 was found to correlate with increased IH rates for PD and DP (OR = 1.87, and OR = 1.86, respectively, P < 0.0001 each), as did postoperative intraabdominal infections (P < 0.0001). Patient-based survey of 104 patients, revealed that 16 patients (15%) reported post-operative IH during the follow-up period. BMI≥30, SSI and intra-abdominal abscesses were associated with increased IH risk (P < 0.05).

Conclusion

Improved survival after pancreatic resection has led to an increased prevalence of long-term surgical sequela. In this study, we demonstrate significant rates of IH among long-term survivors and assess potential risk factors.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).