Department of General, Vascular, and Thoracic Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Langenbecks Arch Surg. 2011 Feb;396(2):179-85. doi: 10.1007/s00423-010-0659-5. Epub 2010 Jun 28.
Incisional hernias are one of the most often complications in abdominal surgery and therefore present a significant surgical and socioeconomic problem. To date, incisional hernias are always an indication for surgery, regardless of the patient's symptoms. However, it remains unclear to what extent the surgery actually results in symptomatic improvement and whether a relevant risk of incarceration exists. The purpose of this study was to investigate the motivation that led to incisional hernia repairs and whether patients benefit from surgery with regard to pain and subjective criteria.
This prospective study included patients who underwent open abdominal incisional hernia repair using mesh implantation. Data collection was done preoperatively and 6 months postoperatively. The intensity of pain was evaluated using the Numeric Analog Scale (NAS). Patients were divided according to their preoperative level of pain into oligosymptomatic (NAS 0-3) and symptomatic (NAS 4-10) groups, and the postoperative outcome of both groups was compared.
Ninety patients were prospectively enrolled: 45 males (50.0%) and 45 females (50.0%); 43 patients (47.8%) were oligosymptomatic preoperatively, while 47 patients (52.2%) reported relevant pain. The most frequent motivation for surgery named by the oligosymptomatic patients was fear of incarceration (79.1%), while the symptomatic patients mostly mentioned pain (76.6%). At 6 months postoperatively, significantly more oligosymptomatic patients complained of relevant pain (p < 0.001). In the symptomatic patient group, there was a significant reduction in relevant pain (p < 0.001). At that time, the level of relevant pain was comparable in both groups (33.3% versus 35.6%). Seven of 87 patients (8.0%) experienced recurrence within 6 months. Three patients with acute incarceration were treated with emergency repair (3.2%).
In patients with oligosymptomatic incisional hernias, fear of incarceration is the most frequent motivation for surgical treatment, even though the actual risk of incarceration seems to be rather low. If the incisional hernia causes relevant discomfort preoperatively, the surgery provides significant relief. In contrast, there is no improvement regarding pain in the oligosymptomatic patient group. This leads to the conclusion that, in the case of oligosymptomatic incisional hernias, the general indication for surgical revision should be viewed critically.
切口疝是腹部外科最常见的并发症之一，因此是一个重大的手术和社会经济问题。迄今为止，无论患者的症状如何，切口疝总是手术指征。然而，手术实际上在多大程度上能改善症状，以及是否存在相关的嵌顿风险，仍不清楚。本研究旨在探讨导致切口疝修复的动机，以及患者在疼痛和主观标准方面是否受益于手术。
本前瞻性研究纳入了使用网片植入物行开放式腹部切口疝修复的患者。数据采集在术前和术后 6 个月进行。使用数字模拟量表（NAS）评估疼痛强度。根据术前疼痛程度将患者分为少症状组（NAS 0-3）和有症状组（NAS 4-10），并比较两组的术后结果。
90 例患者前瞻性入组：男 45 例（50.0%），女 45 例（50.0%）；术前少症状患者 43 例（47.8%），有症状患者 47 例（52.2%）。少症状患者最常见的手术动机是担心嵌顿（79.1%），而有症状患者主要提及疼痛（76.6%）。术后 6 个月，少症状患者中明显更多人抱怨相关疼痛（p<0.001）。在有症状患者组中，相关疼痛显著减轻（p<0.001）。此时，两组的相关疼痛程度相当（33.3%比 35.6%）。87 例患者中有 7 例（8.0%）在 6 个月内复发。3 例急性嵌顿患者接受急诊修复（3.2%）。
在少症状切口疝患者中，担心嵌顿是手术治疗最常见的动机，尽管实际嵌顿风险似乎较低。如果切口疝术前引起相关不适，手术会提供显著缓解。相比之下，少症状患者组的疼痛无改善。这得出结论，对于少症状切口疝，手术修正的一般指征应持批判态度。
