Impact of abdominal compliance on surgical stress and postoperative recovery in laparoscopic groin hernia repair: a retrospective cohort study.

Autor: Kinoshita S; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan. soi1214@naramed-u.ac.jp., Hara C; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan., Matsumoto Y; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan., Fukuoka K; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan., Nakagawa K; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan., Hokuto D; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan., Kuge H; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan., Mukogawa T; Department of Surgery, Yamatotakada Municipal Hospital, 1-1 Isono Kitamachi, Yamatotakada, Nara, Japan.
Jazyk: angličtina
Zdroj: Hernia : the journal of hernias and abdominal wall surgery [Hernia] 2024 Dec 03; Vol. 29 (1), pp. 40. Date of Electronic Publication: 2024 Dec 03.
DOI: 10.1007/s10029-024-03232-4
Abstrakt: Purpose: The role of abdominal compliance in pneumoperitoneum is not fully understood. This study aimed to clarify the association between abdominal wall stretching tendency and surgical stress in laparoscopic groin hernia repair.
Methods: We conducted a retrospective single-center cohort study, evaluating 51 patients who underwent elective transabdominal preperitoneal groin hernia repair. Abdominal compliance was assessed using the abdominal compliance index (ACI; insufflated intra-abdominal volume [L] / body surface area [m²]) at 8 mmHg intra-abdominal pressure. Surgical stress and recovery were evaluated with patient-reported outcome measures (PROMs), including QOR-15 and pain visual analog scale (VAS) scores. Associations between ACI, PROMs, and clinical outcomes were analyzed.
Results: The median ACI was 1.229 L/m² (0.369-2.091). Eleven patients (21.6%) above the 75th percentile cutoff (1.576 L/m²) were categorized as high ACI. While body constitution was similar between groups, the high ACI group had significantly greater insufflated intra-abdominal volume (2.88 L vs. 1.89 L, P < 0.0001). Pre-operative QOR-15 scores were similar. However, on postoperative day 1, the high ACI group had significantly lower QOR-15 scores (90.2 vs. 110.1, P = 0.017), with subcategory analysis showing reduced physical well-being. Multivariate analysis indicated that high ACI was a significant predictor of poorer QOR. The high ACI group also reported higher, though not statistically significant, postoperative pain.
Conclusion: Abdominal walls with greater elasticity, which stretch excessively under pneumoperitoneum, were more susceptible to surgical stress. Further studies are warranted to evaluate the efficacy of tailored pneumoperitoneum pressure adjustment based on abdominal compliance to mitigate surgical stress.
Competing Interests: Declarations. Ethical approval: All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). This study was approved by the institutional review board (Yamatotakada Municipal Hospital Ethics Committee, No. R5-5). Informed consent: Written informed consent was obtained from all patients before treatment. Conflict of interest: All authors declare no conflict of interest.
(© 2024. The Author(s).)
Databáze: MEDLINE
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