Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Surgery. 2013 Jan;153(1):120-5. doi: 10.1016/j.surg.2012.06.003. Epub 2012 Aug 3.
The Ventral Hernia Working Group proposed recently a classification system to grade the risk of surgical site occurrence (SSO) during ventral hernia repair (VHR). Accurately predicting the outcomes of synthetic mesh in open VHR for comorbid patients might guide surgeons in appropriate mesh selection in this patient population. Our objective was to determine the incidence of SSO in open, grade II VHR and to examine the use of synthetic mesh in these comorbid patients.
All open, grade II VHR performed by a single surgeon over a 4-year period were reviewed retrospectively.
Eighty-eight patients (43 female; mean age, 57 years) with grade II ventral hernias underwent open VHR with synthetic mesh. Associated comorbidities included obesity in 55 (63%), diabetes mellitus in 43 (49%), chronic obstructive pulmonary disease in 27 (31%), smoking in 21 (24%), and immunosuppression in 18 (21%). The mean number of comorbidities per patient was 1.9 (range, 1-4). SSO occurred in 14 (16%) patients and included infection (n = 11), seroma (n = 2), and wound dehiscence (n = 1). Having multiple comorbidities was associated with an increased risk of SSO (P = .02). Three (3%) patients required reoperation or readmission for wound management. With a mean follow-up of 17.8 months, 4 (5%) patients developed a hernia recurrence.
Patients with grade II hernias undergoing open VHR are prone to SSO with an incidence of 16%. Although synthetic mesh infections can occur among grade II patients, the majority can be managed conservatively with salvage of the prosthesis, especially if macroporous mesh is used. Given our findings, the use of synthetic mesh in the retrorectus space results in a safe and durable (5% recurrence rate) repair for patients with grade II incisional hernias.
最近，腹疝工作组提出了一种分类系统，用于对腹疝修补术（VHR）中手术部位发生（SSO）的风险进行分级。准确预测复合网片在合并症患者开放 VHR 中的结果可能会指导外科医生在该患者人群中选择合适的网片。我们的目的是确定开放、II 级腹疝 VHR 的 SSO 发生率，并检查在这些合并症患者中使用合成网片的情况。
回顾性分析了一名外科医生在 4 年内进行的所有开放、II 级腹疝 VHR。
88 例（43 例女性；平均年龄 57 岁）II 级腹疝患者接受了开放、II 级腹疝 VHR 并使用合成网片。合并症包括肥胖 55 例（63%）、糖尿病 43 例（49%）、慢性阻塞性肺疾病 27 例（31%）、吸烟 21 例（24%）和免疫抑制 18 例（21%）。每位患者的平均合并症数为 1.9（范围 1-4）。14 例（16%）患者发生 SSO，包括感染 11 例、血清肿 2 例和伤口裂开 1 例。有多种合并症与 SSO 风险增加相关（P=.02）。3 例（3%）患者因伤口管理需要再次手术或再次入院。平均随访 17.8 个月，4 例（5%）患者发生疝复发。
接受开放 VHR 的 II 级疝患者易发生 SSO，发生率为 16%。尽管 II 级患者可能会发生合成网片感染，但大多数患者可以通过保守治疗来挽救假体，特别是使用大孔网片时。根据我们的发现，在腹横筋膜后间隙使用合成网片可为 II 级切口疝患者提供安全且持久（复发率为 5%）的修复。
