Department of Surgery, Kaiser Permanente, 4760 Sunset Boulevard, 3rd Floor, West Los Angeles, CA 90027, USA.
Hernia. 2012 Feb;16(1):41-5. doi: 10.1007/s10029-011-0857-2. Epub 2011 Jul 24.
Contaminated large abdominal wall defects can pose a formidable challenge to the surgeon. This study compared the outcome of components separation (CS) for complex ventral defects with or without contamination.
A retrospective review was conducted of all patients who underwent CS over an 8-year period. Pre-operative factors such as the presence/absence of contamination were analyzed for their effect on length of hospitalization, readmission rate, post-operative complications, re-intervention rate, and long-term recurrence.
A total of 34 patients was analyzed. There were 18 males (53%) with a mean age of 57 years. Mean body mass index was 31 kg/m(2). Seventeen patients (50%) had prior repair (mean 2.1 repairs per patient, median 2). Mean size of abdominal defect was 255 cm(2). Out of the 34 patients, 13 had infected or contaminated defects, including 5 patients with infected mesh. Length of stay was longer in the contaminated group (11.1 vs 3.1 days, P < 0.01). A higher complication rate was noted in the setting of contamination (77 vs 38%, P = 0.03). During a mean follow-up of 47 months, no difference was noted in the re-intervention rate (38 vs 29%, P = 0.70) or long-term recurrence rate of the defect (8 vs 5%, P = 1.0) (contaminated vs non-contaminated group, respectively).
CS is a good option for closure of large contaminated complex abdominal wall defects. Despite an increased risk of postoperative complications and longer hospitalization length, long-term outcomes are favorable.
污染的大腹壁缺损可能对外科医生构成巨大挑战。本研究比较了有或无污染的复杂性腹侧缺损的组件分离（CS）的结果。
对 8 年内接受 CS 的所有患者进行回顾性分析。分析术前是否存在污染等因素对住院时间、再入院率、术后并发症、再次干预率和长期复发的影响。
共分析了 34 例患者。其中男性 18 例（53%），平均年龄 57 岁。平均体重指数为 31 kg/m²。17 例（50%）患者有既往修复史（平均每位患者 2.1 次修复，中位数 2 次）。腹壁缺损的平均大小为 255 cm²。34 例患者中，13 例有感染或污染的缺损，其中 5 例有感染的网片。污染组的住院时间较长（11.1 天 vs. 3.1 天，P < 0.01）。在污染的情况下，并发症发生率更高（77% vs. 38%，P = 0.03）。在平均 47 个月的随访中，再干预率（38% vs. 29%，P = 0.70）或缺陷的长期复发率（8% vs. 5%，P = 1.0）（分别为污染组和非污染组）无差异。
CS 是闭合大污染复杂腹壁缺损的良好选择。尽管术后并发症风险增加和住院时间延长，但长期结果是有利的。
