Comparison of laparoscopic and open surgery on early postoperative liver function and coagulation function in patients with abdominal external hernia and cirrhosis

doi:10.3877/cma.j.issn.1674-392X.2024.06.012

Abstract

Abstract:

Objective

To explore the effects of laparoscopic versus open hernia repair on early postoperative liver function and coagulation function in adult patients with abdominal external hernias complicated by cirrhosis and to assess their clinical significance.

Methods

A retrospective analysis was conducted on the clinical data of 126 adult patients with abdominal external hernias and cirrhosis who underwent hernia repair surgery at the Second Affiliated Hospital of Chongqing Medical University from January 2019 to September 2024.Patients were divided into a laparoscopic surgery group and an open surgery group based on the surgical approach.The primary outcomes included liver function [albumin,alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, Model for End-Stage Liver Disease (MELD) score], coagulation function [prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (FIB)], surgical duration, postoperative complications, and recurrence rates.

Results

There were no significant differences between the two groups regarding age, gender, hypertension, or diabetes.Emergency cases all underwent open surgery, and the laparoscopic surgery group had significantly longer operative times than the open surgery group.A comparison of perioperative liver and coagulation function showed that, in the laparoscopic surgery group,postoperative albumin levels significantly decreased, while ALT, AST, total bilirubin, and MELD scores significantly increased (P＜0.05).In the open surgery group, postoperative albumin, ALT, and AST levels significantly decreased (P＜0.05).The coagulation function parameters of both groups showed no significant changes(P＞0.05).Among patients with Child-Turcotte-Pugh (CTP) class A and B liver function, the laparoscopic surgery group had a lower incidence of postoperative complications and hernia recurrence compared to the open surgery group.However, in CTP class C patients, the incidence of postoperative liver failure and mortality was significantly higher in the laparoscopic surgery group than in the open surgery group.

Conclusion

Laparoscopic surgery has a more pronounced impact on liver function than open hernia repair in patients with abdominal external hernias and cirrhosis.Laparoscopic surgery significantly reduces postoperative complication and recurrence rates in patients with CTP A or B liver function, but significantly increases the risk of liver failure and mortality in patients with CTP C liver function.Therefore, in clinical practice, the choice of surgical approach should be made cautiously, taking into account the patient's specific condition.

Key words: Laparoscopy, Abdominal external hernia, Cirrhosis, Hernia repair, Complications, Safety

Haoyuan Wang, Haiyang Wang, Jianming Sun, Yikuan Chen, Xiaotong Qi, Bo Tang. Comparison of laparoscopic and open surgery on early postoperative liver function and coagulation function in patients with abdominal external hernia and cirrhosis[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 654-659.

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Figures/Tables 5

变量	开放手术组(n=67)	腹腔镜手术组(n=59)	t/χ²值	P
年龄(岁, $\overset{ˉ}{x}$ ±s)	62.01±11.31	61.10±8.29	0.519	0.605
性别[男性,例(%)]	61(91.00)	56(94.90)	0.709	0.400
高血压[例(%)]	21(31.30)	15(25.40)	0.539	0.463
糖尿病[例(%)]	24(35.80)	15(25.40)	1.587	0.208
肝病科转入[例(%)]	18(26.90)	11(18.60)	1.197	0.019
疝的类型[例(%)]
斜疝	52(77.60)	51(86.40)	2.030	0.154
直疝	6(9.00)	8(13.60)	0.815	0.366
脐疝	8(11.90)	0
股疝	1(1.50)	0
嵌顿[例(%)]	15(22.40)	1(1.70)	12.118	0.001
肝硬化病因[例(%)]
HBV	45(67.20)	44(74.60)	6.327	0.012
HCV	3(4.50)	0
HEV	0	1(1.70)
酒精性	15(22.40)	14(23.70)	0.397	0.528
原发性胆汁性	2(3.00)	0
自身免疫性	2(3.00)	0
病程(年, $\overset{ˉ}{x}$ ±s)	6.33±3.91	5.81±4.32	0.705	0.482
腹水[例(%)]	61(91.00)	52(88.10)	0.287	0.036
肝功能损害评分分级[例(%)]
A级	17(25.40)	20(33.90)	0.843	0.383
B级	39(58.20)	33(55.90)	0.180	0.690
C级	11(16.40)	6(10.20)	0.936	0.334
肝性脑病[例(%)]	12(17.90)	7(11.90)	0.896	0.054

变量	开放手术组(n=67)	腹腔镜手术组(n=59)	t/χ²值	P
年龄(岁, $\overset{ˉ}{x}$ ±s)	62.01±11.31	61.10±8.29	0.519	0.605
性别[男性,例(%)]	61(91.00)	56(94.90)	0.709	0.400
高血压[例(%)]	21(31.30)	15(25.40)	0.539	0.463
糖尿病[例(%)]	24(35.80)	15(25.40)	1.587	0.208
肝病科转入[例(%)]	18(26.90)	11(18.60)	1.197	0.019
疝的类型[例(%)]
斜疝	52(77.60)	51(86.40)	2.030	0.154
直疝	6(9.00)	8(13.60)	0.815	0.366
脐疝	8(11.90)	0
股疝	1(1.50)	0
嵌顿[例(%)]	15(22.40)	1(1.70)	12.118	0.001
肝硬化病因[例(%)]
HBV	45(67.20)	44(74.60)	6.327	0.012
HCV	3(4.50)	0
HEV	0	1(1.70)
酒精性	15(22.40)	14(23.70)	0.397	0.528
原发性胆汁性	2(3.00)	0
自身免疫性	2(3.00)	0
病程(年, $\overset{ˉ}{x}$ ±s)	6.33±3.91	5.81±4.32	0.705	0.482
腹水[例(%)]	61(91.00)	52(88.10)	0.287	0.036
肝功能损害评分分级[例(%)]
A级	17(25.40)	20(33.90)	0.843	0.383
B级	39(58.20)	33(55.90)	0.180	0.690
C级	11(16.40)	6(10.20)	0.936	0.334
肝性脑病[例(%)]	12(17.90)	7(11.90)	0.896	0.054

围手术期指标	开放手术组(n=67)	腹腔镜手术组(n=59)	t/χ²值	P值
急诊手术[例(%)]	14(20.90)	0
手术时间(min, $\overset{ˉ}{x}$ ±s)	64.67±23.07	117.86±45.34	8.444	0.015
术中出血(ml, $\overset{ˉ}{x}$ ±s)	60.91±8.65	51.61±9.51	5.748	0.151
麻醉方式[例(%)]
全身麻醉	38(56.70)	59(100.00)	33.172	0.001
腰硬联合麻醉	5(7.50)	0
局部麻醉	24(35.80)	0
麻醉时间(h, $\overset{ˉ}{x}$ ±s)	2.41±0.92	2.87±0.59	3.290	0.041
美国麻醉医师协会分级（ $\overset{ˉ}{x}$ ±s）	2.71±0.41	2.71±0.56	0.000	1.000
置入补片[例(%)]	54(80.60)	54(91.50)	3.060	0.080

围手术期指标	开放手术组(n=67)	腹腔镜手术组(n=59)	t/χ²值	P值
急诊手术[例(%)]	14(20.90)	0
手术时间(min, $\overset{ˉ}{x}$ ±s)	64.67±23.07	117.86±45.34	8.444	0.015
术中出血(ml, $\overset{ˉ}{x}$ ±s)	60.91±8.65	51.61±9.51	5.748	0.151
麻醉方式[例(%)]
全身麻醉	38(56.70)	59(100.00)	33.172	0.001
腰硬联合麻醉	5(7.50)	0
局部麻醉	24(35.80)	0
麻醉时间(h, $\overset{ˉ}{x}$ ±s)	2.41±0.92	2.87±0.59	3.290	0.041
美国麻醉医师协会分级（ $\overset{ˉ}{x}$ ±s）	2.71±0.41	2.71±0.56	0.000	1.000
置入补片[例(%)]	54(80.60)	54(91.50)	3.060	0.080

变量	术前	术后	t/χ²值	P值
活化部分凝血活酶时间(s)	40.89±5.66	42.43±6.54	1.457	0.270
凝血酶原时间(s)	15.78±1.72	16.12±2.13	1.017	0.427
国际标准化比值	1.25±0.18	1.29±0.22	1.152	0.406
纤维蛋白原(μg/ml)	181.32±12.40	177.21±14.32	2.511	0.055
白蛋白(g/L)	35.52±5.92	32.77±5.04	2.895	0.035
谷丙转氨酶(U/L)	26.99±16.21	23.34±11.99	1.482	0.024
谷草转氨酶(U/L)	40.09±22.80	33.66±13.01	2.005	0.049
总胆红素(μmol/L)	27.81±15.61	27.11±14.03	0.273	0.273
终末期肝病模型评分	8.53±3.83	9.84±3.95	1.949	0.125

变量	术前	术后	t/χ²值	P值
活化部分凝血活酶时间(s)	40.64±5.28	41.99±6.06	1.290	0.377
凝血酶原时间(s)	15.52±1.36	16.05±2.83	1.297	0.312
国际标准化比值	1.23±0.14	1.28±0.32	1.100	0.055
纤维蛋白原(μg/ml)	198.31±21.42	184.04±16.56	1.963	0.054
白蛋白(g/L)	35.71±5.75	27.75±4.53	8.352	0.018
谷丙转氨酶(U/L)	32.12±15.17	55.78±31.03	5.262	0.031
谷草转氨酶(U/L)	46.00±27.46	67.68±21.88	4.743	0.047
总胆红素(μmol/L)	25.37±21.41	61.18±29.02	4.627	0.043
终末期肝病模型评分	8.01±3.69	14.48±3.65	9.575	0.033

组别	例数	切口感染	阴囊血肿	肝衰竭	术后疼痛	死亡	复发
CTP A级
开放手术组	17	0	4(23.4)	0	2(11.7)	0	1(5.8)
腹腔镜手术组	20	0	1(5.0)	0	0	0	1(5.0)
CTP B级
开放手术组	39	2(5.1)	0	0	2(5.1)	0	5(12.8)
腹腔镜手术组	33	0	2(6.1)	0	0	0	2(6.1)
CTP C级
开放手术组	11	1(9.1)	2(18.2)	1(9.1)	1(9.1)	0	4(36.4)
腹腔镜手术组	6	0	3(50.0)	4(66.7)	3(50.0)	2(33.3)	1(16.7)

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