Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Hospital, AL 35233, USA.
Am J Surg. 2011 Jul;202(1):28-33. doi: 10.1016/j.amjsurg.2010.10.011.
Prosthetic mesh used for incisional hernia repair (IHR) reduces hernia recurrence. Mesh infection results in significant morbidity and challenges for subsequent abdominal wall reconstruction. The risk factors that lead to mesh explantation are not well known.
This is a multisite cohort study of patients undergoing IHR at 16 Veterans Affairs hospitals from 1998 to 2002.
Of the 1,071 mesh repairs, 55 (5.1%) had subsequent mesh explantation at a median of 7.3 months (interquartile range 1.4-22.2) after IHR with permanent mesh prosthesis. Infection was the most common reason for explantation (69%). No differences were observed by the type of repair. Adjusting for covariates, same-site concomitant surgery (hazard ratio [HR] = 6.3) and postoperative surgical site infection (HR = 6.5) were associated with mesh explantation.
Patients undergoing IHR with concomitant intra-abdominal procedures have a greater than 6-fold increased hazard of subsequent mesh explantation. Permanent prosthetic mesh should be used with caution in this setting.
用于切口疝修补术（IHR）的假体网片可降低疝复发率。网片感染会导致严重的发病率，并对后续的腹壁重建构成挑战。导致网片取出的危险因素尚不清楚。
这是一项在 1998 年至 2002 年间在 16 家退伍军人事务部医院进行 IHR 的多地点队列研究。
在 1071 例网片修复中，55 例（5.1%）在 IHR 后中位数为 7.3 个月（四分位距 1.4-22.2）后进行了永久性网片假体的后续网片取出。感染是最常见的取出原因（69%）。不同的修复类型之间没有观察到差异。调整协变量后，同侧伴随手术（风险比 [HR] = 6.3）和术后手术部位感染（HR = 6.5）与网片取出有关。
在进行 IHR 并伴有腹腔内手术的患者中，随后进行网片取出的风险增加了 6 倍以上。在这种情况下，应谨慎使用永久性假体网片。
