Evans Karen Kim, Chim Harvey, Patel Ketan M, Salgado Christopher J, Mardini Samir
Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA.
Am Surg. 2012 Apr;78(4):388-97.
Repair of ventral hernias constitutes one of the most common surgical procedures. Although an abundance of data exists on objective outcome measures, very little information exists on subjective measures of surgeon preference and patient satisfaction in surgical management of ventral hernias. Moreover, there are minimal data on indications for elective repair of ventral hernias. Two questionnaires were sent to a population of general and plastic surgeons active in hernia surgery. The first of these aimed at gathering information from surgeons about their indications and contraindications for repair of ventral hernias. The second survey was aimed at determining surgeons' perception of patient satisfaction with repair of large ventral hernias (greater than 15 cm width). Five hundred sixty-eight surgeons responded to the first survey and 336 responded to the second survey. The most common indications for elective repair of abdominal wall hernias were generalized pain (68.7%) and cosmesis (54.6%), whereas the most common contraindications were morbid obesity (43.3%), American Society of Anesthesiologists Class III or IV (35.4%), and enterocutaneous fistula (33.1%). The majority of surgeons do not routinely repair large abdominal wall hernias in asymptomatic patients, but 31.6 per cent do repair asymptomatic large hernias. Most surgeons reported that the majority of patients had resolution of pain and subjective impression of improved cosmesis after surgery. This study demonstrates uniform indications and contraindications for surgical repair of ventral hernias among surgeons as well as surgeons' perception of improvements in satisfaction of most patients after surgery. Future studies will focus on comparing surgeon and patient satisfaction.
腹疝修补术是最常见的外科手术之一。尽管在客观疗效指标方面存在大量数据，但在腹疝手术管理中，关于外科医生偏好和患者满意度的主观指标的信息却非常少。此外，关于腹疝择期修补术适应证的数据也极少。向一群活跃于疝手术领域的普通外科医生和整形外科医生发放了两份问卷。第一份问卷旨在收集外科医生关于腹疝修补术的适应证和禁忌证的信息。第二份调查旨在确定外科医生对大型腹疝（宽度大于15厘米）修补术后患者满意度的看法。568名外科医生回复了第一份问卷，336名回复了第二份问卷。腹壁疝择期修补术最常见的适应证是广泛性疼痛（68.7%）和美观问题（54.6%），而最常见的禁忌证是病态肥胖（43.3%）、美国麻醉医师协会Ⅲ或Ⅳ级（35.4%）以及肠皮肤瘘（33.1%）。大多数外科医生不会对无症状患者常规修补大型腹壁疝，但31.6%的医生会修补无症状的大型疝。大多数外科医生报告称，大多数患者术后疼痛缓解，且美观方面有主观改善。这项研究表明外科医生在腹疝手术修补方面的适应证和禁忌证具有一致性，以及外科医生对大多数患者术后满意度改善的看法。未来的研究将集中于比较外科医生和患者的满意度。
