疝手术前的康复与营养

Ramiro Cadena-Semanate, Ramón Díaz Jara, A. Guerron, Jin S. Yoo
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摘要

腹疝修补术(VHR)是美国最常见的外科手术之一。尽管手术技术的进步,相当数量的VHR患者经历术后并发症和疝复发。降低VHR发病率的一个关键策略是在手术前优化患者的康复方案。预康复旨在通过身体调理、营养干预和心理支持来改善患者的功能状态。在其他外科学科中,及时的术前行动已被证明可以显著减少可改变的合并症的负面影响并加速恢复。在本文中,我们回顾了文献,以评估选择性VHR病例中康复的适用性和益处。对现有证据的回顾发现,肥胖、高血糖和吸烟是影响VHR结局的可改变的重要危险因素。康复治疗有可能减轻和控制这些合并症。有氧、阻力和吸气肌训练是有益的。营养干预以控制糖尿病和严重营养不良患者,对合并VHR的患者尤其重要。选择性VHR康复方案的合理目标包括体重指数35 kg/m2,糖化血红蛋白6.5%,戒烟至少4周。预防措施,以尽量减少切口疝的发生率后,初次剖腹手术修复包括补片加固和缝线与伤口长度的比例至少为4:1。
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Prehabilitation and Nutrition in Hernia Surgery
Abstract Ventral hernia repair (VHR) is among the most frequently performed surgical procedures in the United States. Despite advancements in surgical technique, a significant number of VHR patients experience postoperative complications and hernia recurrence. A key strategy to reduce VHR morbidity is patient optimization before surgery with prehabilitation protocols. Prehabilitation aims to improve patients' functional status with physical conditioning, nutritional intervention, and psychological support. In other surgical disciplines, prompt preoperative action has proven to significantly reduce the negative influence of modifiable comorbidities and accelerate recovery. In this article, we review the literature to assess the applicability and benefits of prehabilitation in elective VHR cases. A review of the available evidence identified obesity, hyperglycemia, and smoking as significant modifiable risk factors that negatively affect VHR outcomes. Prehabilitation has the potential to mitigate and control these comorbidities. Physical conditioning with aerobic, resistance, and inspiratory muscle training is beneficial. Nutritional intervention to control diabetes and in severely malnourished patients is especially important in patients undergoing concomitant gastrointestinal procedures with VHR. Reasonable targets for prehabilitation protocols in elective VHR include a body mass index of 35 kg/m2, HbA1C of 6.5% and tobacco abstinence for at least 4 weeks. Prophylactic measures to minimize the rates of incisional hernia after primary laparotomy repairs include mesh reinforcement and a suture to wound length ratio of at least 4:1.
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