当日手术在腹腔镜下选择性修复IV型裂孔疝胸内胃的可行性、结果和可能性。

IF 3.8 2区医学 Q1 SURGERY

Journal of the American College of Surgeons Pub Date : 2025-07-01 Epub Date: 2025-06-13 DOI:10.1097/XCS.0000000000001357

Nikhil Erabelli, Ethan Bui, Shalin Shah, Clarissa Hoffman, Connor Fritz, Farzaneh Banki

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引用次数: 0

摘要

目的：评价当日手术（SDS）在腹腔镜择期胸内胃修复术（ITS）中的可行性、结果和成功率。探讨术中胃嵌顿率对SDS计划的意义。方法：术前影像学将ITS定义为100%胃疝入胸。评估术中胃嵌顿进入胸部的百分比，并将胃部分嵌顿的患者与100%嵌顿的患者进行比较。SDS的规划始于2019年。结果：2012 - 2024年，共有1057例裂孔疝修补术和190/1057例（18%）原发性腹腔镜ITS修补术，其中8例手术术中胃嵌顿比例未被记录，182例手术被纳入，127/182（69.8%）为选择性手术，58/127（45.7%）为术中胃部分嵌顿，69/127（54.3%）为100%嵌顿。自SDS计划开始以来，进行了56次选择性修复。SDS计划率36/56(64.3%)，执行率33/36（91.7%）。比较33/56（58.9%）按SDS进行的手术与23/56（41.1%）未按SDS进行的手术显示出相似的性别/年龄/BMI/ASA。手术时间117 min (IQR, 100-144) vs 129 min (IQR, 110-167), p=0.134；急诊科就诊：5/33 (15.2%)vs 3/23 (13.0%), p=1.00；再入院：4/33 (12.1%)vs 1/23 (4.3%), p=0.64。SDS的几率在性别、年龄、BMI、术中胃嵌顿率和手术时间方面具有可比性。结论：约半数ITS患者术前影像学显示胃疝的比例与术中胃嵌顿的比例无关。SDS在大多数腹腔镜选择性ITS修复中是可行的，并且在术中部分或100%胃嵌顿的患者中可以获得良好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Feasibility, Outcomes, and Odds of Same-Day Surgery in Laparoscopic Elective Repair of Type IV Hiatal Hernia with Intrathoracic Stomach.

Background: To assess the feasibility, outcomes, and odds of same-day surgery (SDS) in the laparoscopic elective primary repair of intrathoracic stomach (ITS). To assess the significance of percentage of intraoperative gastric incarceration in planning SDS.

Study design: ITS was defined as 100% gastric herniation into the chest on preoperative imaging. The percentage of intraoperative gastric incarceration into the chest was assessed, and patients with partial gastric incarceration were compared with those with 100% incarceration. Planning for SDS started in 2019.

Results: From 2012 to 2024, there were 1,057 hiatal hernia repairs and 190 of 1,057 (18%) primary laparoscopic ITS repairs; 8 procedures in which percentage of intraoperative gastric incarceration was not documented were excluded, and 182 procedures were included; 127 of 182 (69.8%) were elective: 58 of 127 (45.7%) had intraoperative partial gastric incarceration and 69 of 127 (54.3%) had 100% incarceration. Since planning for SDS started, there were 56 elective repairs. SDS was planned in 36 of 56 (64.3%) and was performed in 33 of 36 (91.7%). Comparing 33 of 56 (58.9%) procedures performed as SDS to 23 of 56 (41.1%) not performed as SDS showed comparable sex, age, BMI, and American Society of Anesthesiologists class. The operative time was 117 (interquartile range 100 to 144) minutes vs 129 (interquartile range 110 to 167), p = 0.134, emergency department visits were 5 of 33 (15.2%) vs 3 of 23 (13.0%), p = 1.00, and readmissions 4 of 33 (12.1%) vs 1 of 23 (4.3%), p = 0.64. The odds of SDS were comparable for sex, age, BMI, percentage of intraoperative gastric incarceration, and operative time.

Conclusions: The percentage of gastric herniation on preoperative imaging does not correlate with the percentage of intraoperative gastric incarceration in about half of patients with ITS. SDS is feasible in the majority of laparoscopic elective ITS repairs and can be performed with good outcomes in patients with intraoperative partial or 100% gastric incarceration.

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来源期刊

Journal of the American College of Surgeons 医学-外科

CiteScore

6.90

自引率

5.80%

发文量

1515

审稿时长

3-6 weeks

期刊介绍： The Journal of the American College of Surgeons (JACS) is a monthly journal publishing peer-reviewed original contributions on all aspects of surgery. These contributions include, but are not limited to, original clinical studies, review articles, and experimental investigations with clear clinical relevance. In general, case reports are not considered for publication. As the official scientific journal of the American College of Surgeons, JACS has the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.