Altom Laura K, Graham Laura A, Gray Stephen H, Snyder Christopher W, Vick Catherine C, Hawn Mary T
Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, AL 35294, USA.
Am Surg. 2012 Feb;78(2):243-9.
The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. χ(2) tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1-98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures (P < 0.0001). Adjusted Cox proportional hazards models of hernia outcomes resulted in an increased hazard for recurrence among same site clean procedures (Hazard Ratio (HR) = 1.8, P = 0.03) and an increased hazard for mesh explantation among same site clean-contaminated procedures (HR = 8.4, P = 0.002). Concomitant same site procedures are significantly associated with adverse hernia outcomes as compared with isolated IHR or IHR with other site concomitant procedures. The high failure rate of hernia repairs among same site concomitant procedures should be taken into account during the surgical decision-making process.
同期进行切口疝修补术（IHR）与其他外科手术的安全性和有效性尚未得到充分了解。关于在清洁-污染手术中植入永久性补片的结果，存在相互矛盾的报道。本研究的目的是回顾同期外科手术对IHR结果的影响。这是一项对1998年至2002年期间在16家退伍军人事务医院接受择期IHR的患者进行的回顾性多中心队列研究。使用医生提取的手术记录确定同期手术状态、疝的特征和手术细节。从病历中确定疝复发和补片取出的结果。采用χ²检验、Kaplan-Meier曲线和Cox回归分析评估同期手术状态对疝结局的影响。在1495例择期IHR中，75例（4.8%）为同部位同期手术，56例（3.8%）为不同部位同期手术。中位随访69.3个月（范围19.1 - 98.3个月），33.6%的患者出现复发、补片取出或两者皆有。与非同期手术相比，同期手术中植入永久性补片的可能性较小（P < 0.0001）。调整后的疝结局Cox比例风险模型显示，同部位清洁手术中复发风险增加（风险比（HR）= 1.8，P = 0.03），同部位清洁-污染手术中补片取出风险增加（HR = 8.4，P = 0.002）。与单纯IHR或IHR合并其他部位同期手术相比，同部位同期手术与不良疝结局显著相关。在手术决策过程中，应考虑同部位同期手术中疝修补术的高失败率。
