Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0016, USA.
J Am Coll Surg. 2011 Apr;212(4):496-502; discussion 502-4. doi: 10.1016/j.jamcollsurg.2010.12.004.
The frequency of subsequent abdominal operations (SAO) and complications attributable to earlier ventral incisional hernia repair (VIHR) are unknown. We examined the effect of repair type and technique on the difficulty and complications of subsequent surgery.
A cohort of VIHRs at 16 Veterans Affairs hospitals between 1998 and 2002 was examined for postrepair abdominal operation by chart review. The primary independent variable was type and technique of the index VIHR: suture or mesh repair stratified by mesh type and position in relation to abdominal wall musculature. Subsequent surgery characteristics including operative time, inadvertent enterotomy, mesh removal, and length of postoperative stay were determined by chart review. Regression modeling was used to adjust for potential confounding variables.
At a median of 80 months after VIHR in 1,444 patients, 366 (25.3%) experienced SAO. Nearly two-thirds of these involved rerepair of the VIHR with or without a concomitant procedure. Mesh removal was significantly more likely in expanded polytetrafluoroethylene repairs as compared with polypropylene repairs, regardless of technique (odds ratio = 3.6; p = 0.01). On multivariable regression modeling, polypropylene underlay (p = 0.03) and inlay (p = 0.001) and absorbable/biologic mesh (p = 0.05) significantly increased operative time for SAO. Repair type, mesh type, or position had no significant effect on risk of inadvertent enterotomy during the SAO (p≥0.27).
Subsequent abdominal operations after VIHR are common. Underlay or inlay polypropylene mesh increases SAO operative time, but there was no increased risk of intestinal injury. Earlier repair with expanded polytetrafluoroethylene did not increase operative time, but there was equivalent risk for intestinal injury and increased risk for mesh removal.
先前腹侧切口疝修补术（VIHR）后再次腹部手术（SAO）的频率和并发症尚不清楚。我们研究了修复类型和技术对后续手术难度和并发症的影响。
通过病历回顾，对 1998 年至 2002 年期间在 16 家退伍军人事务部医院进行的 VIHR 后腹部手术进行了研究。主要的独立变量是指数 VIHR 的类型和技术：缝线或网片修复，分层为网片类型和与腹壁肌肉的关系。通过病历回顾确定了后续手术的特征，包括手术时间、意外肠切开术、网片去除和术后住院时间。回归模型用于调整潜在的混杂变量。
在 1444 例 VIHR 后中位数为 80 个月时，有 366 例（25.3%）发生 SAO。其中近三分之二涉及 VIHR 的再次修复，同时或不伴有同时进行的手术。与聚丙烯修复相比，无论采用何种技术，膨体聚四氟乙烯修复的网片去除更有可能（比值比=3.6；p=0.01）。在多变量回归模型中，聚丙烯底层（p=0.03）和衬里（p=0.001）以及可吸收/生物网片（p=0.05）显著增加了 SAO 的手术时间。修复类型、网片类型或位置对 SAO 期间意外肠切开术的风险没有显著影响（p≥0.27）。
VIHR 后再次进行腹部手术很常见。底层或衬里聚丙烯网片增加了 SAO 的手术时间，但没有增加肠损伤的风险。早期使用膨体聚四氟乙烯修复并没有增加手术时间，但肠损伤的风险相等，网片去除的风险增加。
